We know that social determinants of health contribute greatly to overall patient outcomes, for better and for worse. This has been a major focus area for Passport Health Plan, particularly in underserved areas of the Commonwealth. Passport CEO Scott Bowers recently spoke about social determinants of health alongside Theresa Reno-Weber (United Way) at the Converge Louisville conference.
At the conference, Scott shared some initial data from a social needs pilot Passport conducted amongst members in care management programs from January to August of this year. The pilot intended to better understand the impact of referrals to social services on member health outcomes. That program leveraged data and technology, including geospatial mapping, social needs analytics, and a social services referral platform to help identify our highest risk members who would benefit from further engagement—primarily in the form of referrals to community resources that the Passport team helps them navigate.
Some of Passport’s key findings below:
- Among the 1,958 members identified for social needs outreach, 84% of them self-reported a social need and 56% reported multiple needs. Food (34%), employment (23%) and housing (16%) are the most commonly reported issues related to social determinants of health.
- Per member per month costs dropped by approximately 22% in the 6 months after a member followed through on a referral to a community resource. That translates to savings of roughly $390 per member per month.
This work highlights the importance of identifying and targeting the right members at the right time and ensuring a successful connection to high-quality services in their community that can be digitally tracked to support evaluation of outcomes.
The value of Passport’s efforts in this arena are multifaceted:
1) they’re helping members recognize the most pressing—and costly—issues they face,
2) they’re connecting them with the available resources they need to overcome them, and
3) they’ll have even better outcomes tracking because of this new ecosystem enabling them to close the loop on community referrals.
And our preliminary data from this pilot program indicates that the model, which looks at the patients holistically, is working to reduce costs among the Medicaid population.