By Jessica Robinson
A recent industry analysis estimates that 40 percent of clinical outcomes are determined by social and economic factors, while 30 percent are due to patient behaviors, and 10 percent are attributed to the physical environment, such as transportation and housing. That leaves only 20 percent of outcomes that are driven by direct clinical care.
For healthcare providers, that small impact on outcomes may seem discouraging. However, what this finding also shows is tremendous opportunity to explore new care delivery methods that confront the other 80 percent. Telehealth, for example, has the potential to engage patients, change behaviors, and overcome some of these non-clinical factors, which are typically grouped under the social determinants of health category.
Defined as “the immediate and structural conditions in which people are born, grow, live, work, and age,” SDOH can be more efficiently and effectively confronted through telehealth for numerous reasons. One of the most important is that it removes many barriers to accessing physical care. Moreover, when used in conjunction with a population health management strategy and platform that is integrated with the telehealth solution, providers can identify and begin overcoming SDOH challenges.
Starting with the basics
Delivering care to patients at their home through a computer or mobile device is gaining strong acceptance across the country, driven mainly by consumers and employers. A recent survey shows that 77 percent of consumers are interested in receiving more care through telehealth, while 96 percent of employers offered telehealth benefits in their company health plans.
Adoption is also poised to increase among providers. The CMS Next Generation ACO program, for example, recently released a waiver that eliminates current medical facility and geographic restrictions for assigned beneficiaries, allowing them to receive telehealth services from their home. Other new legislation, such as the 21st Century Cures Act, may also remove those restrictions when Congress reviews a report on telehealth payment policies in 2018.
All of these telehealth trends can help overcome many SDOH obstacles, the most immediate of which are transportation challenges. Allowing patients to remain in their home to receive care eliminates that hardship while also enabling patients with physical limitations — another SDOH challenge — to access care more easily.
Understanding social determinants of health
Determining if a patient falls into a social determinant category that would prevent them from accessing care or adhering to a care plan can be a challenge. However, it may be as simple as asking some pertinent questions during registration at an office visit. For example, asking the patient if they have reliable transportation to and from a provider’s facility is an important question, as is inquiring if their work schedule permits them access to care during typical business hours.
Once that data is gathered, it can be aggregated with medical histories and other clinical information to be analyzed through a PHM platform that helps care managers identify and monitor patients who may need additional support. That insight might reveal that a patient is an ideal candidate for a telehealth-augmented care plan. Regardless, PHM and telehealth platform integration is critical to ensure efficiency and that providers have seamless access to the data they need at the point of virtual care.
Further information can be captured about a patient’s SDOH through a home visit combined with a simultaneous virtual visit. Using the organization’s PHM platform, a care manager can arrange a home visit where a nurse or other clinician can meet with the patient to discuss care plan adherence obstacles and conduct an assessment of the home environment. If needed, that clinician can contact a physician or other specialized healthcare professional through a virtual visit so that the patient can ask questions and obtain needed guidance immediately and with less effort, reducing the risk of unnecessary accidents or potential crisis situations from occurring.
Telehealth care quality
Not only can patients overcome some care access challenges more easily, but many patients report a more positive and meaningful care experience through telehealth. That finding is likely because delivering care through telehealth requires physicians to concentrate on the patient through their computer monitor, which can eliminate some of the distractions of a busy medical facility. That concentration, combined with a limitation to only visual and aural observation, means conversations can be more interactive and engaged. The patient, too, is less distracted and more at-ease speaking to the physician from the comfort of their own home.
Further, telehealth is ideal for high-need patients who may need more regular provider visits. Often, regular encounters with these patients serve as check-ins for vital signs and to see how the patient is doing. Most high-need patients have equipment available in their homes to monitor their vitals, and telehealth allows their provider to touch base on how they look and are feeling, without having to work around space or scheduling restrictions. This streamlined visit opens up providers to spent appropriate time and attention on these patients, while opening up their office space and appointment slots for more crucial or urgent cases.
Above all, strengthening that engagement can overcome SDOH obstacles that are leading patients and providers away from their care goals. When used in conjunction with a PHM strategy that helps identify and align telehealth resources with appropriate patients, ACOs and other clinically integrated networks can achieve the outcomes that distinguish themselves in their respective markets as high-performance organizations.
Jessica Robinson is VP of product management and delivery for The Garage in Orlando.