How SDOH data impacts telehealth access and how Payers can use it to improve outcomes

Payers are continuously looking to improve health outcomes. Removing barriers to care and improving care access through analyzing social determinants of health (SDOH) data is a key strategy.

The social determinants of health (SDOH) include education, housing, transportation, income as well as other factors including where people are born, raised, live and work that impact their health and their ability to access care. In the United States, SDOH account for 30-55% of health outcomes and payers are leveraging SDOH data to identify care gaps and improve healthcare in underserved communities.

“Payers are concerned about access to care [and] what kind of programs need to be developed in order to get the appropriate care to the right people,” explains Russell Robbins MD, Chief Medical Information Officer at PurpleLab®. “Data about SDOH are essential to shed light on the inequalities in care per populations in payers’ plans…and how they can then use that information to develop appropriate care plans.”

Research suggests that the best outcomes could be achieved when payers expand their telehealth coverage to include more providers and close the healthcare divide in rural areas, which could reduce unnecessary costs.

The need for data

Patient-level SDOH data provides essential insights into resource gaps and allows payers and providers to deploy resources and create treatment plans that can best support patients. 

Based on the SDOH data, payers may decide to waive co-pays for members below a specific income threshold; data can also help to measure and determine if such decisions increase medication adherence or decrease hospital stays.

Going beyond just linking SDOH data to a three-digit zip code, PurpleLab connects physicians with de-identified SDOH attributes including race, ethnicity, education and income data. Physicians can use this data to create actionable insights for implementing care plans and reaching underserved communities.

“Payers and Providers can use patient-level SDOH information to understand what is going on in terms of readmission rates and outcomes,” Robbins adds. “Without the patient data, [payers] have no way of knowing.”

Example:  Demo of SDOH in HealthNexus Platform.

Driving outcomes

Telehealth use exploded during the pandemic and rates were especially high in certain populations. Mor than one-third of persons with disabilities scheduled virtual visits during the pandemic, including 43.3% of people with mobility disabilities. Telehealth use was also high in rural areas where it expanded access to healthcare and reduced or minimized burdens to accessing timely care. One survey found that 63% of patients felt their medical and social needs were met during virtual visits.  

While telehealth has the potential to provide care to underserved communities, payers need data for decision making. Payers can use PurpleLab data to understand populations of people with disabilities and the rural versus urban mix of patients to create care plans that enhance telehealth access in these populations. Data can also help health plans identify providers with large populations of patients who live in rural areas or have disabilities to enhance recruitment efforts. 

Robbins is hearing from more payers using data to drive decision making, adding, “The crux of what payers are trying to do is understand the needs of segments of their population that they haven’t been able to address and they’re starting to demand the data upfront before they start to try to implement programs and make these shifts.”  

Making telehealth accessible

The COVID-19 pandemic accelerated the adoption of telehealth. Robbins credits three factors for the 300-fold increase in virtual visits during the pandemic: patients lacked access to clinic appointments, providers who were ambivalent about offering telehealth had no other options, and commercial health plans began covering the cost of virtual visits.

“The big barriers for not wanting to do telehealth were removed and things came together to make it work,” Robbins explains. “Now, people are more willing to do telehealth and more accepting of it.”

Data from PurpleLab show that telehealth visits have declined since their peak in April 2020 but remain above pre-pandemic levels, highlighting a continued demand for virtual care. 

By understanding the connection between SDOH and telehealth, payers can generate actionable insights to reduce fragmented care and optimize plan offerings to make virtual care more efficient without exacerbating healthcare inequities.

Originally published on February 26, 2024 in HealthcareDive. This article was written in collaboration with Industry Dive and PurpleLab®.

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