Viewpoints

Opinion and analysis on managing care from experts and KOLs

Health Plans Start To Focus More On Social Needs of Beneficiaries

Gerard A. Vitti

Your health is strongly influenced by dozens of factors, but we commonly chalk it up to our genes, a few behaviors like smoking or eating poorly, and access to good medical and dental care.

But your ZIP code may be just as important. If you are fortunate enough to live in a clean, safe neighborhood, you stand a better chance of enjoying good health than someone who doesn’t.

Distance between neighborhoods isn’t necessarily a big factor. My home in Milton, a leafy, affluent suburb of Boston, is less than a mile from the city’s Mattapan neighborhood, yet these two communities have dramatically different rates of chronic disease. For example, emergency room visits for asthma and diabetes are more than two times higher in Mattapan than in Milton.

Gerard A. Vitti

Why does where we live—and the resources we have available to us—affect our health in such a significant way? Because those resources give us the wherewithal to get access to the type of care and services we need. In Milton, orthodontia is a rite of passage for teens; in Mattapan, there are children who have gone years without visiting a dentist.

The resource gap is particularly pronounced when it comes to an individual with a disability. Raising a child with a disability is an immense undertaking. It is a full-time job just ensuring that your child gets the care and support that he or she needs. I know, because I have a daughter with a rare physical, intellectual, and psychiatric disability. My wife, Erin, and I have resources, and we don’t have to think twice about how my daughter will get to a medical appointment or how we can get some support so that we don’t burn out as caregivers.

But for low-income families struggling to get by—including those living just a mile from us in Mattapan—all of these things that pose no problem to us become major barriers. Nothing is easy. For families without a car, rides need to be carefully coordinated. Appointments are missed, so care becomes disjointed, fraying the doctor–patient relationship and undermining people’s understanding of their health problems.

Lack of government spending on health is not the main reason we have these health challenges. Rather, it’s a question of not spending money in the right way—and at the right time. Prevention is key. We need to invest in helping people stay healthy rather than treating them after they get sick.

Address social needs

Health plans have known for years that there are many nonhealth factors that play a role in a person’s health and well being. That’s why many plans have gone to such lengths to invest in prevention by promoting fitness and creating member newsletters that address issues like healthful eating.

Now a coterie of health plans is starting to tackle factors that were seen as being completely outside the purview of anyone in the health care system, let alone a health plan.

A project undertaken by the UPMC Health Plan in Pittsburgh showed that providing housing and other social supports to individuals on its Medicaid health plan led to a 23% decrease in total costs.

A similar pilot project in Massachusetts that provided case management and other social supports to a chronically homeless population generated a return of between $1.61 and $2.43 for every dollar invested in the program, according to a study recently conducted by the Boston University School of Social Work.

New strategies are needed to address health disparities. Investing in community services, not just clinical ones, should become the rule rather than the exception for Medicaid agencies and others serving low-income populations.

Managed care organizations that serve people covered by Medicaid and served by other public insurance programs are best suited to devise strategies that can narrow the health gap. They know this population, and they know what works. Operating outside the bounds of government, they can tap into an entrepreneurial spirit and data-driven tolerance for risk to devise strategies that have never been tried before.

John F. Kennedy famously said, “Life is unfair.” And indeed it is. But we can take steps by freeing up government to innovate and let our managed care plans help lead the way, so health outcomes are less unfair.

Gerard A. Vitti is the founder and CEO of Healthcare Financial, a company based in Quincy, Mass., that helps individuals get health coverage.

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