The Center for Improving Value in Healthcare (CIVHC) is a nonprofit, non-partisan organization in Denver, CO, working to improve the health of Coloradans and increase the value of the healthcare they receive. CIVHC is the administrator of the Colorado All Payer Claims Database, a collection of paid claims data from most Colorado going back to 2009.

Part of our mission is to work with organizations and individuals across the state to find ways to put the data we have into action. We have long recognized that though claims data is an invaluable source of insight and information, it cannot tell the whole story of healthcare and value – we must work to connect to other data to see the complete picture of what is happening in our healthcare system and what direction we should turn.

Largest Gaps

Two years ago, under the guidance of the Colorado Prevention Alliance we started collaborating with a group of payers, providers and systems to look at what the health system was missing to be more effective.

Out of the work of that group came an overwhelming consensus that the largest gap was addressing the impact of non-medical factors on health after people left the hospital or physician’s office. Accessing the right food, getting transportation to the pharmacy, finding child care for follow up appointments and other factors were making people sicker and preventing health.

We had serious concerns about the way these social determinants of health were being addressed within the healthcare system, including inconsistent and unreliable access, unsustainable need and a complete lack of data around use, need and the impact of those services on healthcare utilization and outcomes.

These concerns were echoed by the hundreds of stakeholders, providers, and community-based resources we have talked to in the last two years:

• Any access to information about available community resources is out of date and unreliable.
• Access to information about community resources is highly regional and unhelpful to those travelling sometimes hundreds of miles for care. These individuals need support in their local communities, not the communities where they receive care.
• There is little data about capacity of community based resources, no data about the level of need for various supports, no data about any excess capacity that may exist in certain programs, and no data about what interventions and supports did the most to improve health and reduce avoidable health system use.
• The data available from state agencies fails to account for the substantial support from outside the state infrastructure.
• Available data sets don’t align with each other and don’t align with healthcare data.
• There is no reimbursement for providers taking the time to connect patients with services.
• There is no reimbursement for community-based resources to provide these services, and only minimal state support for state agency resources.

CIVHC is working with this collaborative to create the consistent data we need to connect these social support and non-medical services with claims data and to prove the return on investment from food banks, transportation assistance, housing support, and many other services.

There is little data currently available from community-based resources, and the data available from the state are frequently unaligned with each other, and with healthcare claims and clinical data, making it exceptionally challenging to create a comprehensive picture of the health and cost benefits from social and non-medical supports.

With the current payment reform movement towards value based reimbursement, episodic payment and global capitation, it’s impossible to continue to ignore the role that the social determinants play in healthcare use and behaviors.

Social support services can reduce readmissions, improve at home follow-up and recovery rates, and can help catch complications sooner, among other things. Even CMS has acknowledged the need for hospitals and facilities to have the flexibility to address some of these non-medical needs and has, for the first time, begun to reimburse for these services through the payment flexibility of the Comprehensive Joint Bundle and others.

We intuitively know these services support health, but demonstrating how and to what extent, determining what services provide the most value for limited resources, and evaluating which patients are most in need are challenges that have not yet been met. Ongoing work within the state of Colorado will create an opportunity to collectively address these challenges and find the answers we need to create a system that can provide true health rather than just healthcare.

-Kristin Paulson, JD, is director of Health Care Programs at the Center for Improving Value in Health Care in Denver, CO.

Conference Explores Healthcare Game Changers

The Kentuckiana Health Collaborative (KHC) will hold its third annual conference on March 15 in Louisville, Ky. The conference is titled, The 2017 Healthcare Question: What’s Coming, What’s Going? – Game Changers, Measurement Mayhem, and Payment Fixes.

Kristin Paulson will be one of three panelists in the afternoon session discussing healthcare’s role in addressing social determinants of health. Most experts agree that 80 percent of what drives a person’s health is outside of the clinical care setting. How do the healthcare system and the community address the socioeconomic factors that impede individuals from reaching their fullest potential?

This conference will also explore measurement, data, and payment innovation; cultural competency; and the game changers that could be in store over the next few years.

Find out more about the conference and register at KHCollaborative.org.