SDOH Spenders Spawn SDOH Vendors

Social determinants of health have been edging into the health care discussion for decades, but in the last few years payers and providers have been plowing millions into the once-marginal idea. And now SDOH has spawned a new group of specialized vendors selling software platforms that connect providers and patients with social service providers and other resources.

If the current infatuation with SDOH turns into something more permanent, these companies will be ready not just with products but with an ambition to remake the way care is provided.

“Our big focus is how [to] bring human and social service providers to the same priority level as health care,” says Taylor Justice, president of Unite Us, the platform chosen by Kaiser Permanente to handle social determinants work across the nine states in which it operates. North Carolina is requiring its Medicaid managed care organizations to use Unite Us.

Justice says that when he and CEO Dan Brillman cofounded the company in 2013, “people looked at us like we were crazy. Human and social services weren’t sexy.” That all has changed: 2019 “has just been kind of a whirlwind,” he says. People tell him now that “I need an enterprisewide solution, and I need it by this day.”

The sums going into SDOH projects mean there’s plenty of money to be made by software entrepreneurs like Justice. UnitedHealthcare announced in March that it had invested more than $400 million in affordable housing “to remove social barriers to health.” ProMedica, a not-for-profit hospital chain in Ohio, announced in 2017 that it would invest $50 million “to help revitalize metro Toledo and surrounding communities” with programs to boost education, employment, and family stability. The list could go on. In Washington, a bipartisan group of legislators introduced a bill in July that would give up to $25 million to states and local governments to coordinate “health and non-health services” for high-needs Medicaid patients.

Splurging on SDOH is not without its critics. Just because health is influenced by social factors doesn’t mean that health care institutions have the expertise to fix them, says Amitabh Chandra, a Harvard health care economist. He takes issue with the claim that addressing social determinants will reduce costs. “There’s a lot of payers who don’t want to do the hard work of reducing costs the usual way,” which means that they would “say no to things” and design narrower networks, says Chandra. “They’re terrified of having their name vilified on the front page of a newspaper, saying this national insurer said no to this gene therapy because it costs too much.”

It’s easier to cover something and pass on the costs, says Chandra, and then hold up their SDOH programs as proof that they’re doing something to curb health care spending. Messaging the SDOH programs as cost savers can also be used as a tactic to keep regulators from allowing more competition, he contends.

But SDOH proponents say they have the numbers to back up their efforts. ProMedica’s 30-day readmission rate fell 53% for Medicaid patients who visited its grocery store “food clinic,” according to its chief medical offer. Meanwhile, SDOH managers at Montefiore Health System in the Bronx say they have saved money by temporarily housing discharged patients who don’t have a home to go to. The four residential respite beds, which Montefiore started providing in 2014, have saved the hospital at least three times more than what the beds cost, according to Keona Serrano, who manages projects for the Montefiore Housing at Risk Program. To calculate its return on investment, the hospital counts how much it would cost to house patients at the hospital instead of the residential beds, where patients typically stay 90 days, and adds in the revenue earned by typical patients who can use the vacant beds instead.