Social and economic conditions such as housing, food security, employment, and education can account for as much as 80 percent of health outcomes and are increasingly being recognized as an important driver of health care costs (Magnan, 2017). Despite the significant impact these factors have on the health of individuals and communities, health care organizations struggle to leverage their resources to respond.
UPMC Health Plan seeks to serve our community and shape the health care system of tomorrow as part of the second-largest integrated delivery and finance system in the country. Our goal is to provide members with the right care, in the right way, at the right time. Success with this goal often depends on many social factors, referred to as social determinants of health (SDoH).
Social determinants vs. social needs
The national conversation around health care reform continues—and with it, an increased interest in wellness and prevention. SDoH, a concept that has been around for at least a decade, gained traction in the health care industry in 2019 as an upstream way to achieve more value-based care.
SDoH, as defined by the World Health Organization, are “the conditions in which people are born, grow, live, work, and age and are shaped by the distribution of money, power, and resources” (World Health Organization, 2017). Social determinants tend to be systemic, societal challenges that will be solved through long-term upstream investments and collaboration between government, the public sector, and private industry.
A similar concept is social needs. In the context of health care, these are immediate barriers a member or patient faces in accessing the care they need. Many headline-grabbing health care investments to date that have been framed as addressing social determinants are instead meeting an immediate social need.
Increasing and expanding the public transportation system of a community is a social determinant and will require collaboration, government involvement, and investment. A health insurance company that provides a ride service for doctor’s appointments as part of a benefits package, like UPMC for Life offers, addresses an immediate social need to reduce a barrier to care.
Coordinating UPMC’s efforts
In December 2019, the Center for Social Impact was launched to coordinate, evaluate, and expand programming and innovations that address both the social needs and social determinants of the communities UPMC serves. The Center for Social Impact will be housed within the UPMC Center for High-Value Health Care, an organization within UPMC Insurance Services Division that translates the work of UPMC’s unique payer-provider laboratory into evidence-based practice and policy change for improving health care equality and efficiency.
“Cataloging our many programs and contributions, evaluating their results, and scaling and replicating what works is at the heart of this effort,” said Ray Prushnok, the executive director of the Center. “The Center for Social Impact applies our analytic strengths and evidence-based approaches to address social needs in the communities we serve and will create insights for others who are entering this space.”
This process of aggregation, evaluation, and scaling is an effort to solve the “silo” challenge that so many organizations face. Siloed programs often increase administrative burden and result in patient and member confusion. By consolidating efforts in this SDoH space within the Center, there is the opportunity to better coordinate and integrate services across various populations and programs to optimize their utilization and impact.
Innovating and expanding into social needs and determinants is a natural evolution for the UPMC Insurance Services Division. From its inception, UPMC’s approach has been founded on the principle of whole-person care for our members and patients, demonstrated by our nationally recognized approach to behavioral and physical health integration and more than $1 billion in annual community benefits. Integrating social needs into this framework and exploring social determinants initiatives continues and expands UPMC’s tradition of holistic, quality care.
What we’re working on
UPMC Health Plan is already leading the industry in transforming care delivery and the health care ecosystem through innovation, and our commitment to social initiatives goes back at least a decade. The Center for Social Impact will begin with a focus on three key domains: addressing social needs, coordinating and expanding access to benefits, and supporting underserved communities. Activities pursued by the Center will fall into one, two, or all of these categories. Examples include housing, employment and workforce training, improved service coordination with local government, rural health care, and addressing the unique needs of individuals with intellectual and developmental disabilities or the LGBTQI+ populations UPMC Health Plan serves.
When thinking about how to address the social needs of the community, it can often seem like the sky is the limit. In order to maximize our impact, we intend to grow intentionally into new areas. The current areas of interest include:
- Food security
- Medical-legal partnership
- Childcare and caregiver support
- Social isolation and dementia
As the Center for Social Impact expands into these areas and continues the work we are already engaged in, we welcome feedback from our customers, partners, and community leaders with ways to move forward together.
World Health Organization, 2017