What are the 5 domains of health care?

The five social determinants of health domains encompass economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context.

healthpayerintelligence.com - Top 5 Social Determinants of Health Domains for Payers to Address

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Source: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion

By Kelsey Waddill

October 23, 2020 - There are five social determinants of health domains, according to the Office of Disease Prevention and Health Promotion (ODPHP) Healthy People 2030 website. While certain domains will at times require more urgent attention than others, a robust social determinants of health strategy may seek to address all five. The five social determinants of health domains encompass economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context. Social determinants of health strategies should first and foremost be anchored in the communities that the health plans are serving. However, payers can also evaluate their approach's comprehensiveness by assessing how they align with the five social determinants of health domains.

Economic stability

Economic instability could result in poverty, employment, food insecurity, and housing insecurity.

“People with steady employment are less likely to live in poverty and more likely to be healthy, but many people have trouble finding and keeping a job,” ODPHP explains. “People with disabilities, injuries, or conditions like arthritis may be especially limited in their ability to work. In addition, many people with steady work still don’t earn enough to afford the things they need to stay healthy.” To help serve members in unstable economic conditions, payers can connect members with employment programs and career counseling. Lacking child care can hold members back from succeeding in the workplace and achieving financial stability, so supporting their child care access can be useful. During times of widespread economic distress, payers can support members’ financial stability through premium credits, grace period extensions, and offering special enrollment periods. CMS lowered the premiums on the individual and small group health insurance markets using premium credits in August 2020. The agency recommended that states do the same on their state exchanges, as some private payers did. Payers typically offer grace periods on premium payments for both members and employers. But in economic downturns, as the nation experienced in the first quarter of 2020, companies like UnitedHealthcare saw consumers make more use of grace periods than normal. UnitedHealthcare reported that grace period payments jumped from 0.4 percent of their average monthly premium base to three percent. In 2020, UnitedHealthcare along with other private and public payers extended special enrollment periods, which allowed individuals who had lost their jobs to enroll in a new plan mid-year. Payers can also philanthropically invest in organizations that support member employment. For example, early on in 2020, Humana invested nearly one million dollars into two organizations in New Orleans, each serving the locally unemployed or underemployed population through training and other resources.

Education access, quality

Enrollment in higher-level education is a key factor in health. A strong educational background sets up children for a higher income later in life and better healthcare. “Children from low-income families, children with disabilities, and children who routinely experience forms of social discrimination — like bullying — are more likely to struggle with math and reading,” ODPHP says in its Healthy People 2030 objectives. “In addition, some children live in places with poorly performing schools, and many families can’t afford to send their children to college. The stress of living in poverty can also affect children’s brain development, making it harder for them to do well in school.”

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Payer interventions that support childhood health and schooling and help connect students with opportunities to pay for their college tuition can ensure that this is less of a burden on members. Payers can coordinate with local school systems to understand and meet the educational needs of that area. Some payers support the local education system by contributing towards broadband internet. Children without internet access may struggle to complete homework assignments or connect with their classes virtually. Payers have also engaged in preventive care within school systems. Childhood vaccinations are considered critical to a strong population health strategy overall. Payers can disseminate information about free vaccinations and educate members on why these vaccines are important.

Healthcare access, quality

Healthcare access and quality barriers can manifest themselves in numerous ways. However, Healthy People 2030 calls out uninsurance, lack of transportation, and barriers to primary care access as a few examples. “Sometimes people don’t get recommended health care services, like cancer screenings, because they don’t have a primary care provider. Other times, it’s because they live too far away from health care providers who offer them,” ODPHP comments. “Strategies to increase insurance coverage rates are critical for making sure more people get important health care services, like preventive care and treatment for chronic illnesses.” By reducing uninsurance and providing comprehensive benefits, health plans are well-suited to addressing this social determinant of health. They can also help connect members with the appropriate specialists and primary care physicians to improve their health. Offering these services at an affordable price is also key to making these resources accessible.

Digital solutions can be key to connecting specific populations with primary care.

For example, as a generation, Millennials provided a perfect example of why primary care access is critical and how digital platforms can break that trend. A recent Blue Cross Blue Shield Association (BCBSA) report revealed that about a third of Millennials struggle with behavioral conditions, yet many lacked a primary care provider. “We found Millennials were significantly below the number of baby boomers and generation X-ers that had a primary care provider,” Mark Talluto, vice president of strategy and analytics for the BCBSA, told HealthPayerIntelligence. “That's critical because that primary care provider obviously is an avenue in a way in which that millennial member could at least begin to communicate with and access the health care system.” Without a strong relationship with a primary care provider who integrates behavioral healthcare into her primary care services, a Millennial may not realize that he has a behavioral health condition or may not know what steps to take toward treatment. Millennials wanted integrated behavioral-primary care services. They are looking for healthcare resources that fit their busy, complex schedules. And they feel comfortable with exercising telehealth solutions to meet their behavioral healthcare needs. Once payers understand what Millennials are seeking in their primary care providers, health plans should adjust their provider finders as well as their digital and in-person platforms to better serve this population.

Neighborhood, built environment

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This domain includes access to healthy foods, quality of housing, crime and violence, and environmental conditions. Some neighborhoods do not have safe areas for communities to exercise, such as parks or bike lanes. Workplaces and low-income areas might suffer from higher exposure to air pollution, secondhand smoke, or loud sounds that can affect members’ health. “Racial/ethnic minorities and people with low incomes are more likely to live in places with these risks,” ODPHP notes. Because these social determinants of health needs—such as housing and food insecurity— often intertwine, payers can leverage one program to serve multiple social determinants of health at once. For example, with its Social Impact Initiative, the University of Pittsburgh Medical Center (UPMC) Health Plan combined its multiple social determinants of health efforts to pursue a more cohesive strategy. UPMC received data from the county to get a local perspective on the social determinants that members and the local community face. The initiative included a partnership with a local housing and urban development vendor to offer stable housing to homeless individuals as well as food insecurity solutions and more. Though the initiative was spearheaded by UPMC’s government products business, UPMC considered it relevant for other lines of business as well.

Social, community context

Social cohesion or having a strong social network can be critical for mental, behavioral, and clinical conditions. “Positive relationships at home, at work, and in the community can help reduce these negative impacts. But some people — like children whose parents are in jail and adolescents who are bullied — often don’t get support from loved ones or others,” states ODPHP. Racism, discrimination, and violence can be included in this domain. Language and literacy skills can influence whether members are able to connect with their neighbors, provider, or health plan care coordinator. Connecting members with social and community support can help reduce the risks for many health issues.

Payer-run community resource centers can be a hub for community support.

After Blue Shield Promise and LA Care had to temporarily close down their community resource center early on in 2020, the payers began to receive calls asking when in-person classes would restart. “It just points out some of the hidden value of the centers, which is that they really act as social hubs in the community,” Francisco Oaxaca, chief communications and community relations officer at LA Care, explained to HealthPayerIntelligence. “They give folks a safe, fun place to gather and not only receive services and information and take classes, but just to gather and make new friends, keep existing relationships. There seems to be real desire to be able to recapture that.” As the payers slowly begin reopening their centers, they have made sure to blend personal interaction with their digital services. The new telehealth hubs that now exist at some of their sites allow locals to both connect with a healthcare provider virtually and receive in-person help.

healthpayerintelligence.com - Top 5 Social Determinants of Health Domains for Payers to Address