Integrating Social Determinants of Health Into the Care Mainstream

Video transcript

Ryan Daniels: In our view, investments and social determinants of health and health equity is a major trend to keep an eye on both in the healthcare services and healthcare information technology space. And this is a topic we recently addressed in our quarterly healthcare mosaic report, which we titled Achieving the Healthcare Trifecta - Integrating Social Determinants of Health and Health Equity Into the Care Mainstream.

So what do we mean by healthcare trifecta? Well, there's been broad recognition over the last decade of the need to integrate physical and behavioral healthcare. But we think the third component to achieve true population health must be social determinants of health.

Those are items outside of the typical care continuum, which can actually have a significant impact on the health and wellness of a population. So think of things like access to sustainable and healthy foods, access to transportation, secure housing, and the ability to stay at home without becoming isolated among other things.

So why is this important in the healthcare journey? Well, let me give you a brief case study. Imagine there's an individual who recently lost her husband. She has a heart attack and subsequently is taken by the ambulance to the emergency department, is treated at a hospital and then discharged back to her home. After this, there's a wide variety of requirements for her to stay healthy, follow-up visits to a reference lab, the ability to get prescription drug, visits to her physician and maybe specialist visits.

Now if we don't look at her ability to get transportation, which previously was delivered by her husband who's no longer around, we're going to miss a potential gap in care. And although it's not medical or behavioral, it's critical for that individual to have that access to transportation or the entire healthcare delivery chain can fall apart. And because of this recognition and the move to more value-based care, payers, providers, physicians and pharmaceutical companies are all making massive investments in social determinants of health.

In addition to that, COVID-19 exposed vast inequities in access to healthcare both in person and digitally across the United States. So these same payers, providers, patients, and pharmaceutical companies are investing heavily to ensure that all Americans have access to healthcare.

If we look at each of these key constituents we see a variety of activities that are formulating that we think present a big growth opportunity in a multi-billion-dollar total addressable market or TAM, which will take part over the next decade. So first off, in regards to the payer market, we look to the government. They're increasingly pushing regulations to require insurance companies to collect data on social determinants of health. They're also starting to allow providers and insurance companies to pay for social determinants of health. This previously was not legal under a lot of plans, but Medicare Advantage for example, which is one of the largest insurers of seniors in the United States can now pay for things like transportation and healthy meals.

And in fact, 55% of all insurance companies are now paying for produce or healthy meal delivery services for their seniors recognizing that diet can be a source of nutrition and food can act as medicine for constituents across the board. Similarly, investments are being made in affordable housing. Entities like United Health Care have already invested $500 million in housing. Kaiser Foundation $200 million and they recently increased that to $400 million, and there's a lot of investments going on today for transportation. A good example of that is a recent partnership between CVS and Uber which will allow free transportation to their clinics for those in need. Lyft also works with a variety of vendors to provide transportation to follow-up medical visits for those in need across a variety of payer groups, and pharmaceutical companies are both providing access to their medicines as well as funding health equity programs all across the United States. And again, we think this momentum is only increasing with pressure to increase equity and to make these investments as we move towards value-based care.

Another fascinating area in our view is the investments that payers are making to help individuals avoid social isolation. One of the big trends we've talked about in our healthcare group over time is the movement of care to the home, and the ability with technology to enable seniors to both be discharged to home safely and to live at home and age in place more safely versus having to go to facilities like assisted living, senior living or skilled nursing facilities.

But as part of that ability to stay at home there becomes a risk of social isolation. And a fascinating study by Humana recently indicated that the risk of social isolation is as heavy as smoking 15 cigarettes every day. A similar study by Humana also determined that seniors who are socially isolated for long periods of time have a 91% higher risk of developing dementia over time. And because of this, they're starting to make massive investments to reach out and integrate into social activities within their communities in their member base.

One great example of this is a company called Papa which actually rents grandchildren to individuals to help them come over and do chores, to help them do shopping or just to come over and engage them in social activities to avoid that isolation.

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