By Richard Frank, MD, MHSA, Senior Vice President for Medical Affairs for Vida Health |
The future of healthcare hinges on reducing costs beyond the walls of doctors’ offices and hospitals; Healthcare has to solve for the challenges of patients’ own lived environments.
It’s no secret that the United States spends more on healthcare than any other country. And those expenses are trending upward. Healthcare spending grew 9.7 percent in 2020 and reached $4.1 trillion, accounting for 19.7 of the nation’s Gross Domestic Product (GDP). With inflation and security threats growing, we must rein in our healthcare spending before it takes over our entire GDP. The trillion-dollar question is: how?
Can we solve for social barriers to care?
Thankfully we’re beginning to recognize that other factors, besides just cutting-edge medical interventions, make a big difference in a person’s health. In fact, socioeconomic conditions, health behaviors, and physical environmental factors drive 80% of a person’s health outcomes, according to the American Hospital Association. These are what we call social determinants of health (SDOH).
In more detail, SDoH includes a person’s socioeconomic status, level of education, social support networks, employment status, physical environment (including housing and safety), race, culture, sexual orientation, food insecurity, and access to healthcare. Each of these social determinants can predict disease burden, influence health outcomes, and impact total cost of care.
So, what can we in healthcare do to counter some of those environmental challenges in order to restore population health and bring down skyrocketing costs?
We start with chronic disease
More than half of all US adults have at least one chronic condition, and those conditions account for 86% of all healthcare costs in the country. Not surprisingly, the burden of chronic disease falls disproportionately on those who face many social barriers to care. People with low socioeconomic status or who live in areas with high rates of poverty are more likely to suffer from diabetes and hypertension.
Certainly, while more investment in low-income communities would be invaluable to combatting some of those challenges, we can also look toward new health-tech innovations to tackle these issues.
Virtual cardiometabolic solutions are increasing access to care. Rather than having to drive miles to brick-and-mortar doctor’s offices and navigate the ins-and-outs of various specialty practices, patients can get immediate access to a wide network of providers. The best solutions can match people with specialists like diabetes educators, dietitians, health coaches, therapists, and pharmacists to help support them through a range of cardiometabolic challenges that often exist in tandem — like hypertension and diabetes.
If we’re going to make a dent in healthcare spending, we must focus on the chronic conditions that drive the most costs — while understanding that no one-size-fits-all approach will work for everyone.
Recognize that health is personal
People seeking care need to be met where they are — regardless of geography or socioeconomic status.
Licensed case managers (LCMs) can make a big difference in triaging care for individuals who face various barriers to care. Sometimes that care is simply helping people locate food banks or identifying nutritious food sources at local convenience stores (especially in rural areas where grocery stores are miles away). Other times, it includes pointing someone to a local resource for recovery and addiction support.
We must recognize that people have varied needs when it comes to their health. Most needs aren’t even terribly expensive to meet. But when we ignore those fundamental necessities and let people fall through the cracks, we pay an enormous cost in public health and dollars spent.
Proactively focus on prevention
Patients need easier access to personalized care rather than relying on local hospitals as a catch-all. Not only is hospital capacity stretched thin, but it’s also the most expensive avenue for delivering care. Hospital expenditures now account for $1.27 trillion, even though Americans are only getting sicker — and often end up back at the hospital within a month of discharge.
Studies show that areas with high levels of poverty correlate with higher levels of 30-day hospital readmission rates, particularly for heart attack and heart failure. And those hospital readmissions are costly to the US healthcare system — racking up costs of approximately $17.4 billion every year.
Proactively matching people to dietitians, health coaches, and mental health support can be essential in preventing the progression of diseases that lead to inpatient admissions in the first place. In fact, an estimated 80% of heart disease and 90% of type 2 diabetes is preventable through lifestyle changes like diet and exercise.
Hospital readmissions suggest a failure in caregiving. When patients lack preventive and follow-up care — whether due to poor communication or inaccessibility — it can be hugely detrimental to their health outcomes. Instead, we should be proactively focusing on more preventive methods of treatment and promoting strong provider-patient relationships built on trust.
Ease social isolation and address mental health
One such preventive treatment method is to offer ubiquitous mental healthcare — especially to those prone to chronic conditions.
A 2020 Milliman report found that medical costs are close to three times higher for patients who suffer from a mental health or substance use disorder on top of other physical problems than for those who only have physical health problems. In effect, this subgroup of people accounts for 44% of all healthcare spending.
The pandemic laid bare how social isolation affects mental health, often compounding physical conditions as well. Isolation and loneliness are linked to sleeplessness, poor cardiovascular health, weight gain, and cognitive function.
By increasing access to mental healthcare, particularly for older Americans, we can help buffer the effects of social isolation and promote more positive health habits.
True health equity is a lofty goal, but a worthy one. Not only does it better align with our nation’s values, it’s one, very practical way to help balance the budget. By addressing social determinants of health head-on, we can drive down costs and build a more promising future.
About The Author
Dr. Frank is a physician executive with more than 25 years of diverse provider and payer experience. Most recently he served as the Chief Innovation Officer of myNEXUS, a home healthcare benefits management company. Previously he served as the Chief Medical Officer of Aspire Health — the largest community based palliative care company in the country, led CareMore Health’s centralized care management and pharmacy teams, and served as Anthem’s VP of HealthCare Management for the Government Business Division. Dr. Frank has significant experience managing high risk/multi-morbid Medicare and Medicaid populations and their healthcare utilization, developing new business for established and VC backed companies, engaging providers in value-based contracts, and implementing clinical programs within not-for-profit, private equity, and publicly traded companies.
Dr. Frank is a board-certified anesthesiologist. He completed his Medical Degree at the University of Michigan Medical School and earned a Master’s Degree in Health Services Administration at the University’s School of Public Health.