Social determinants of health (SDOH) are the conditions within an environment where people are born, learn, worship, work, play, live, and age. These factors are grouped into five domains: social and community context, neighborhood and built environment, education access and quality, economic stability, and healthcare access and quality.
SDOH are critical influencers on an individual’s health, quality of life, and health outcomes. Those with a low socioeconomic status and those living in disadvantaged neighborhoods are more likely to be readmitted to the hospital. Accurately identifying individuals who will be readmitted to the hospital due to SDOH risk factors is crucial to lowering costs for payers and improving Centers for Medicare and Medicaid Services Star Ratings.
Learn how taking a strategic approach to addressing SDOH through virtual care solutions is key to reducing hospital readmissions.
How Virtual Care Solutions Are Key to Reducing Hospital Readmissions
Addressing SDOH is crucial to reducing hospital readmissions. Let’s explore how virtual care solutions may be the key.
Predictive Modeling
Including SDOH in predictive models for 30-day readmission has the potential to impact quality improvement strategies and programs that address social needs. By including SDOH factors in predictive models, stakeholders can accurately identify and target members who are at high risk for potentially avoidable readmission.
Without models that include SDOH factors, there isn’t just a lack of information about member characteristics—there’s also a lack of information on who to target to address SDOH factors that could lead to avoidable readmissions.
Risk Stratification
Healthcare today is value-based, meaning high-quality care must be provided, and healthcare must be focused on health outcomes rather than the number of services delivered. As health systems pivot to this model, it’s clear that greater member engagement is needed.
Member engagement strategies typically focus on helping members understand their condition and treatment outcomes, and risk stratification plays an important role in this process. Risk stratification enables stakeholders to identify members who are at risk of readmission based on data that reflects the member’s lifestyle, medical history, and vital health indicators. It also allows payers to assess a population’s risks and identify trends.
By identifying each member’s unique risks, payers are able to determine the best way to engage members in their healthcare and then deliver targeted telecare outreach. For example, low-risk members may benefit most from preventive medicine and annual checkups, while members with uncontrolled chronic conditions such as diabetes could benefit from remote monitoring solutions.
Reducing Hospital Readmissions
Remote monitoring programs and follow-up systems are key to reducing hospital readmissions. According to a study published by the Global Journal on Quality and Safety in Healthcare, members who receive follow-up interventions are less likely to be readmitted to the hospital. Virtual care solutions make follow-up even easier through features such as interactive voice response, which has been shown to reduce hospital readmissions.
Follow-up systems and remote monitoring programs are also beneficial to improving medication adherence and reducing hospital readmissions. Research has found that medication nonadherence accounts for 33-69 percent of hospital readmissions, indicating that a member may have quit taking their medication or didn’t complete their prescription. Therefore, assisting members with medication adherence may help lower the rate of hospital readmissions.
Lowering Cost of Care
Telehealth offers a modern way to solve challenges payers face, such as managing healthcare costs and improving member care. Virtual care solutions, such as remote monitoring and telehealth, provide tools that enable payers to enhance access to care while lowering costs.
A 70-month, peer-reviewed study on remote monitoring for individuals with heart failure found that remote monitoring can significantly reduce hospital readmissions and lower costs. The study used an interactive voice response system to ask the study participants a series of questions designed to detect changes in their physical condition that could indicate exacerbation. Study results found:
- 23 percent reduction in hospital readmissions
- 44 percent reduction in 30-day readmission
- 38 percent reduction in 90-day readmission
- 11 percent cost savings
- 3.3 x ROI
The study results point to the benefits of remote monitoring for payers and members alike, especially in the management of chronic conditions.
Ready to Realize the Value of an SDOH Strategy?
A strong SDOH program is critical to the efficacy of a member’s program for payers while contributing to a more engaged membership. Check out our playbook, Extending Clinical Reach: A Practical Guide to Addressing and Impacting Social Determinants of Health, to find out how to assess and enhance your SDOH strategy to ensure you have a successful SDOH program.
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