SDOH solutions: Improving population health outcomes

PART 1 LINA HENG: Hi, I'm Lina Heng, and I'm joined by Raj Madhure, an SDOH expert. Today, we'll be discussing social determinants of health and their impact on population health outcomes.  RAJ MADHURE: Thank you for having me. It's a pleasure to be here.  LINA HENG: It's a pleasure to have you. So let's start with the basics. What are the specific SDOH that we need to address in our population, Raj?  RAJ MADHURE: SDOH are the social conditions that people have that can impact their health outcomes. There's a growing recognition in the healthcare industry that if I don't address an individual's social care needs, they can't be healthy. So we address these needs individually, and then we look at how we're doing in improving those at a population level. LINA HENG: That's good to know. So how can we actually obtain this data so that we know what the impacts are?  RAJ MADHURE:  We start by screening. The best practice in our industry is for providers and health plans to screen individuals, at the point of clinical care, to be asking them about their social care needs. The industry has standardized around Prepare as the screener that everyone uses. And then post screening, we have the referral itself. What referrals are made, information associated with the referral and then, ultimately, how that individual was served. We can then enrich that data with predictive analytics, using the information that's publicly available, to make sure that we're helping the right people in addressing their needs. LINA HENG: That makes sense. Now, I'm curious, how can we actually use that technology to improve our understanding and implement those effective interventions?  RAJ MADHURE:  I think the thing to remember is that hospitals have been doing social care for years. There used to be phone books that would be sitting at the hospital reception. Over time, you had databases and spreadsheets, but fundamentally it was the same thing. By using a closed-loop referral workflow, we can collect, analyze, and share information on SDOH factors. We can use predictive data to identify those individuals who are at risk for poor health outcomes and then target interventions. And then we can wrapper that around other types of programs that Optum and others do, things like telehealth, to improve the individual's access to health care and to address barriers like transportation.  LINA HENG: That makes sense. Now, I'm just curious, how can we actually engage our employees and stakeholders so we can implement the solution? RAJ MADHURE:  One of the things our customers are sometimes surprised by is how much social care happens out in public. We are doing press releases and community events alongside every implementation. The fact is, none of this works unless the community is aware of what we're doing. And what's really neat is a lot of times we're plugging into relationships that our customers have out in communities. This could be social groups, church organizations that they are engaging with in their personal lives.