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Proven and Emerging Best Practices in Social Determinants of Health National Association of State Human Services Finance Officers Conference
Confidential and Proprietary Information
October 10, 2019
Centene Overview
Centene is a leader in government-sponsored healthcare
Confidential and Proprietary Information 3
48,100
W H O W E A R E W H A T W E D O
32 stateswith government sponsored healthcare programs
~340 Product / Market Solutions14.7M Managed
Care Members
FORTUNE 500(2019)
#51
PURPOSETransforming the health of the community, one person at a time
Centene provides access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well, and be well.
FORTUNE GLOBAL 500 LIST
#210EMPLOYEES
PILLARS Focus on the Individual
Whole Health
Active Local Involvement
Centene successfully provides high quality, whole health solutions for our diverse membership by recognizing the significance of the many different cultures our members represent and by forming partnerships in communities that bridge social, ethnic and economic gaps
International Markets3 $72.8−$73.6 Expected Revenue
for 2019
Our purpose and mission are naturally aligned to addressing SDoH
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Transforming the health of the community, one person at a time
Better health outcomes at lower costs
Focus on the Individual
Whole Health
Active Local Involvement
OUR PURPOSE
OUR MISSION
OUR PILLARS
OUR BELIEFS
We believe in treating people with kindness, respect and dignity empowershealthy decisions.
We believe we must treat the whole person, not just the physical body.
We believe we have a responsibility to remove barriers and make it simple to get well, stay well, and be well.
We believe local partnerships enable meaningful, accessible healthcare.
We believe healthier individuals create more vibrant families and communities.
Confidential and Proprietary Information
Social Determinants of Health:Overview
Life expectancy can vary significantly between neighborhoods only a few miles apart
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Why such stark differences between neighborhoods?
“Gaps in health across neighborhoods can stem from multiple factors, ranging from scarce educational or income opportunities, to unsafe or unhealthy housing, to limited access to good hospitals and primary care.”
Robert Wood Johnson Foundation https://www.rwjf.org/en/library/articles-and-news/2015/09/city-maps.html Accessed March 16, 2019
New York City: 9 years
St. Louis, MO: 12 years
New Orleans, LA: 25 years
Social, environmental, and behavioral factors drive the majority of healthcare outcomes
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SOCIAL, ENVIRONMENTAL, BEHAVIORAL FACTORS
60%HEALTH CARE
10%GENETICS
30%
Adapted from https://www.nejm.org/doi/full/10.1056/NEJMsa073350
Addressing the social determinants of health (SDoH) enables improved health outcomes for individuals and communities
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“The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.
The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences
in health status seen within and between countries.”
- The World Health Organization
CORE ELEMENTS• Housing Instability
• Food Insecurity
• Transportation
• Employment
• Education
• Safety
• Social isolation supports
• Financial Security
Social Determinants of Health:Approach
Centene’s history is rooted in addressing the social determinants of health – leading to decades of experience developing SDoH practices
From inception, Centene has appreciated the importance of the social determinants of health. We remain committed to acting locally, delivering whole health, and focusing on the needs of the individual and their family to effect the best health outcomes.
Examples of our focus on SDoH include:• Care Management and the Health Risk Assessment
• Use of Community Benefit Organization (CBO) technology platforms
• Creation of national programs to support our members• Population-specific offerings that address SDoH
• Innovative pilot programs that test new models of care
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SDoH practices are aligned to our care model and innovation practices, ensuring continuous iteration and learning
Care Model Innovation Approach
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Identify SDoH Barriers in the Community
Identify Available Resources & Gaps
Convene Community Stakeholders
Leverage Evidence-Based Best Practice Interventions & Measures
Deploy Localized Program
MEASURE | EVALUATE | ITERATE
Measurable outcomes and innovative partnerships enable value based arrangements – creating potential for truly sustainable impact.
IDENTIFY Population Health Needs STRATIFY For Impactable Subpopulation MANAGE Pilot Development and Implementation MEASURE Health Outcomes and/or ROI DISSEMINATE Programs with Positive Outcomes
Centene has developed an SDoH risk score to power our ability to conduct proactive outreach and support for membersThe purpose of this model and score is to provide a single metric useful to identify and target members at-risk for adverse health outcomes due to the social, economic, and environmental conditions they experience in order to inform delivery of personalized and cost-effective managed care.
Social, economic, and environmental conditions are significant predictors of health. Poverty indicators, education level, and minority status are associated with access to healthful foods, neighborhood safety, and receipt of quality medical care, for example.
Confidential and Proprietary Information
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30%Enhanced predictive power to understand drivers of health expenditures
250+Indicators considered to determine SDoH risk for each member
CNC Care Management and the Health Risk Screening (HRS) & Assessment (HRA) Support SDoH• Social determinants are infused throughout the care/service planning process,
starting with the completion of an initial HRS and followed by a subsequent HRA when indicated (Note: HRAs are required for all LTSS & MMP members)
• HRA frequency will vary, at least once per year and during any change (e.g., if member is hospitalized, moves from institution to community)
• HRA is divided into specific sections, including SDOH-based questions throughout each section
• Employment• Residential Living Environment• Living Preferences• Nutrition• Community Integration / Independence• Transportation
• Results of the HRA are reflected in the member’s care/service plan
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CNC National Programs support SDoH
• MemberConnections®- Visiting members where they live and working to help them navigate the complex healthcare system and get them the community resources they need.
• Start Smart For Your Baby®-Helping our members manage their pregnancy and the baby’s first year of life.
• CentAccount®- Promoting personal healthcare responsibility and ownership by offering members financial incentives for performing certain healthy behaviors. Cards can be used on healthcare related items, transportation fees such as bus passes, and utility bills.
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CNC LTSS & MMP Product Benefit Design supports SDoH• LTSS & MMP programs often include SDoH-related benefits, and
several plans offer value added benefits• Benefit offerings vary by market
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Covered Benefits Value Added Benefits
Employment Food-Supported Employment-Career Assessment -Farmers market vouchers/gift cards
-Job Coaching and Job Finding -Home delivered meals (non-HCBS waivers)Food Transportation
-Home Delivered Meals -Non-medical transportationTransportation -Medically necessary wheelchair van
-Medical and Non Medical Transportation Housing & Transition Benefits
Housing & Transition Benefits -Home maintenance and minor home adaptation
-Home modification and adaptation services -Non-medical assistive devices-Pest control -Transition support-Transition services
9% Reduction in inpatient behavioral health visits per month
Centene pilots SDoH programs that achieve demonstrable results in identifying SDoH risk and improving healthcare outcomes
Participating in a Continuum of Care to integrate homelessness data and coordinate entry resulted in improved health outcomes and costs
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15-18%Reduction in cost for non-emergency medical transportation
136%Return on investment in community hub program for maternal & infant health ($2.36 for every $1 invested)
30%Enhanced predictive power to understand drivers of health expenditures
Community Hub Rideshare SDoH Risk ScoreDevelopment of an SDoH risk score powers our ability to conduct proactive outreach and support for members
Partnership between a health plan and community hub improved birth outcomes for high-risk members
Rideshare pilot programs demonstrate improvement in quality and reduction in cost across several populations
Housing
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Housing • Continuum of Care (AZ) – 20% decrease in homeless members; 13% decreased costs
Food • SNAP/WIC Enrollment (MO, MS) – Pilots ongoing
• Food Bucks (KS, OR, OH, LA) – Pilots ongoing
• Veggie Rx (OR) – Nearly 2x diabetic weight loss
Education • Read It & Eat (AZ) – Increased food literacy
• GoNoodle Partnership (CA) – 13% weight improvement; improved math & reading scores
Employment • Workforce Development & Training Programs (KS, IN, MS) – Access to employment & training
Transportation • Rideshare (OH, FL, GA, TX, NV, MO, CA) –15-18% reduced member costs; 66% decrease complaints
Community Access
• Community Hub Model (OH) – $2.36 ROI per $1
• CBO Tech Platform (MO, TX, WI, FL, NH, CA, NE, OR, OH, LA) – Pilots ongoing
