SDoH analytics: How trustworthy is the data?

CMS.gov shared that U.S. health care spending increased 9.7 percent and reached $4.1 trillion in 2020.  The health “share” of the economy is projected to rise from 17.7 percent in 2018 to 19.7 percent in 2028. The most significant driver behind this is primarily driven by increases in health sector wages.

What this means for employers as plan sponsors:

As a payor, you’ll want to have the right tools and/or partnerships in place to be able to accurately anticipate and confidently strategize regarding your portion of costs.

What to do:

Offset increases in costs by optimizing plan performance.  Use analytics to surface savings opportunities.  Your job is much harder given the Great Resignation and turnover being at a multi-year high.  You’ll need a refreshed and keen understanding of a changing workforce’s needs, utilization patterns, and engagement preferences.

Let’s assume you made solid decisions around carriers and plans, plan administration, and complimentary policies or programs.  Now, get the most out of these choices and proactively drive to the highest level of value possible.  Use the tremendous amount of data available, to refine a benefits strategy and HR policies that make it easy for people to engage with on-demand affordable care options.

We’re watching the pandemic amplify changes in the adoption of virtual care and at-home care. We see business investment and digital innovation compliment longstanding desires for an increasingly streamlined, affordable system with improved care access and health equity.

Providers and carriers continue to explore and innovate business models, so value-based care options and accountable care organizations are growing.  There are countless new market entrants in the wellness and point solution space.

What this means for employers as plan sponsors:

2022 invites enormous opportunity to drive change by partnering with emerging DEI leaders who bring passion and creativity to evolving program design in ways that accommodate a broader set of needs.  The very qualities that make us unique and special and our social environments (both home and at work) influence what works well for each of us when it relates to health.  Employers that can measure what’s working for whom are set up to make smart and responsible benefits design decisions tailored for their population.

What to do:

Create a data-driven, measurable DEI and SDoH framework around your benefit offerings.  This could be looking at traditional metrics by salary range or race, incorporating third-party regional SDoH data, or even looking at variances in condition prevalence based on job types. Look at a minimum of 2 years of baseline data and prioritize equity gaps and key drivers.  Host small group lunches to ask employees for context around what you see in the numbers.  Engage with health plan- and community-based resources alternatives.  With analytic discipline surrounding your efforts, and a multi-disciplinary approach, you will literally see the impact joining forces can have.

Literally.  The need for mental health services is increased, and mental health has a known influence on physical health and overall health costs.  A Kaiser Family Foundation (KFF) study found that during the pandemic, about 4 in 10 adults in the U.S. have reported symptoms of anxiety or depressive disorder, up from one in ten adults who reported these symptoms from January to June 2019.  One insurance company published mental health claims increased by 25% in 2020.

What this means for employers as plan sponsors:

Recognize your ability to support the whole person through benefits design.  Hit the streets and ask your employees what’s important and what is needed.

What to do:

It’s a great time to listen to what people say, and measure what they do.  In addition to adding mental health benefits, pilot environmental changes.  How do a blend of policy updates (e.g. mandatory meeting-free lunch-and-wellness hour?) and benefits expansion (coupled with a wellness program with fitness incentives) associate to employee satisfaction survey data and business goal measurement?  The data exists.  It’s just a matter of analyzing it.

Talk turns into reality.  AI and ML are being applied for clinical innovation in areas like medical imaging, drug discovery, genetic medicine development, and to predict disease before it happens or in early stages.  These are areas beyond an Employer’s realm.  But these same technical innovations are useful in population health management, for planning, resource management, and targeted communications.

What this means for employers as plan sponsors:

You’ll see more and more talk about health Big Data being used to define health experiences that:

• Personalize care
• Address diverse needs and preferences
• Increase engagement

As an Employer, you are set to take a leading role in putting health data to work using AI, ML, and predictive analytics.  You have access to significant data, control of working conditions and environment, and a trusted relationship with individuals.  Why would you want to?  You can create a culture that grooms healthier people, inviting short-term and long-term advantages: increase health, lower health costs, improve retention, increase productivity

What to do:

Right now – use AI, ML, and predictive analytics to plan resources, build business continuity and forecast costs more accurately.  Next, dig into rising risk groups and identify actions that influence toward a more positive outcome.  Find vendors that have embraced these technological opportunities – and ask them to articulate how their strategies drive savings for you, as a payor.