- Taking a proactive approach to addressing the social determinants of health within a patient’s community can translate into measurably higher quality-of-life scores, Humana says in a new peer-reviewed article.
By working within the community to reduce negative socioeconomic circumstances, Humana was able to increase patient-reported “healthy days” by 3.1 percent, as measured by the CDC’s Health-Related Quality of Life survey (HRQoL).
Food insecurity and social isolation or loneliness had the biggest impact on individuals, the study found. Addressing these two factors offered the most significant opportunities to improve overall patient health and increase the number of self-reported healthy days.
"The link between social determinants of health and Healthy Days is substantial,” said Pattie Dale Tye, Segment Vice President and senior lead of the Bold Goal population health strategy, Humana’s initiative to improve overall health by 20 percent by the year 2020.
“Through our research, interventions and national partnerships we know that by working to eliminate barriers to health, we can have an enormous impact on health outcomes and quality of life."
The study, which includes two community case studies, stresses the importance of using data analytics strategies to track and measure the impacts of population health management programs.
Standardized measurement tools, such as the HRQoL, provide stakeholders with objective benchmarks for assessing non-clinical factors associated with patient wellbeing, such as the ability to engage in typical activities including work and recreation.
“We are pleased that we were able to design a robust Bold Goal tracking plan,” added study co-author Gil Haugh, Director of Clinical Analytics at Humana. “Early on, we investigated best practices in complex sample survey methods and consulted with outside experts in population health who had experience using the Healthy Days survey.”
The simple survey, which has been used extensively in national data collection efforts, asks patients four questions about their overall health status:
- Would you say that in general your health is excellent, very good, good, fair, or poor?
- Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?
- Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?
- During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?
In 2014, Humana started to use the survey to examine associations between survey results and patient lifestyle, clinical, and social factors.
“Responses to questions 2 and 3 about recent unhealthy days yield a summary index for an individual,” the study explains. “Individual Healthy Days responses can then be aggregated to population averages to allow observation of population trends over time.”
By 2016, the payer was actively using its data to guide partnerships with community stakeholders geared towards improving chronic disease management and reducing non-clinical factors known to contribute to poor adherence or outcomes.
Two case studies included in the article offer more detailed insights into how to achieve measurable results.
In San Antonio, a mature Humana market with high rates of chronic disease and low community health scores, Humana partnered with local leadership organizations including SA 2020, the Bexar County Medical Society, the San Antonio Food Bank, and the Mayor’s Fitness Council to improve population health.
Kicking off the collaboration in 2014 with a two-day town hall event, the groups formed an advisory board of community members, chaired by physician leaders, to help identify opportunities for improvement.
At the time, 13 percent of individuals in Bexar County experienced food insecurity, and a similar number had limited access to healthy goods. The San Antonio Food Bank and MCCI Medical Group, a primary care organization, partnered to create food distribution sites within MCCI’s community activity centers.
To complement the nutrition program, the town hall identified numerous low-cost or free resources to help the region’s diabetic patients get control of their chronic conditions. In 2014, more than 11 percent of patients in the San Antonio metro area had diabetes, compared to the national average of 9.7 percent.
“Despite the volume of resources, leaders of many of the programs were unaware of other related programs, and clinicians or other sources of referrals had no central reference to identify the available programs to meet the needs of a given individual,” the study notes.
“With support from the local American Diabetes Association, the Diabetes Resources Guide has been developed as an interactive website that aids physicians and patients in selecting the most appropriate diabetes programs.”
The combination of the two programs reduced the number of reported unhealthy days by 9 percent between 2015 and 2016.
“Both physically and mentally unhealthy days dropped,” Humana says. “As the inaugural Bold Goal Community, San Antonio has been a learning laboratory to inform work in additional Bold Goal communities, and the work continues. In 2017, the fourth annual Clinical Town Hall will be held.”
Knoxville, Tennessee offered similar opportunities to improve the experiences of patients in their communities. High prevalence of chronic diseases, including a 10.5 percent diabetes rate, 28.6 percent obesity rate, and 33.4 percent rate of hypertension, indicated a need for effective population health interventions.
With 16 percent of area residents living below the poverty line and 14 percent experiencing food insecurity, Knoxville stakeholders identified four major challenges to better health: access to mental health providers, awareness of resources, nutrition literacy, and financial trade-offs that often left healthy lifestyle choices on the back burner.
Community leaders started up cooking demonstrations and diabetes management classes in accessible settings, such as faith-based organizations, Boys and Girls Clubs, senior centers, and low-income housing developments.
A mobile health pilot explored whether outreach through text messages and other mobile communications could help individuals establish and maintain stronger relationships with care providers.
At Walgreens locations, individuals have access to comprehensive medication reviews to ensure that patients are adhering to their regimens safely and affordably.
“Relative to San Antonio, the work in Knoxville is still in its infancy,” Humana noted. “However, there are signs that health is improving. Between 2015 and 2016, mean unhealthy days declined by 4.8 percent (-0.61 absolute), representing declines in both physically and mentally unhealthy days.”
“Because self-reported unhealthy days are correlated with disease prevalence, this may be an indicator that health in Knoxville is beginning to improve.”
Both case studies are supported by data analytics efforts that combine information on social determinants of health with clinical, pharmacy, claims, and other data sources.
Sharing insights with community partners, then using the data to plan new interventions to address specific needs, is starting to show promising results for targeted communities, Humana concluded.
“We’re proud of these early Healthy Days results,” said study author Andrew Renda, MD MPH. “And the innovative analysis on social determinants has significantly influenced our population health strategy to focus on food insecurity and loneliness/social isolation.”
“This makes us optimistic that we’re on the right track, and that, with more focused and scaled social determinant interventions, we will see even better results in the future.”