If there's one point a recent session at America's Health Insurance Plans Institute & Expo 2017 brought home, it's that if providers and payers are going to manage their members as a population, they need to start by knowing them individually.
To do this, health organizations need data, not just about medical conditions derived from traditional sources like claims, but information and insights derived from a patient's social conditions. The social determinants of health have proven to correlate with health outcomes and risks.
Here's the facts uncovered by LexisNexis® Health Care, a company that provides data insights and analytics for payers, providers, life science organizations and the retail pharmacy sector. Social factors are a component in one out of three deaths.1 Social isolation can increase the risk of heart disease by 29 percent, and the risk of stroke by 32 percent.2 Well over half – 75 percent to 90 percent – of primary care visits are due to the effects of stress.3 The top three pressure points are moving, work and family. This type of information is NOT found in traditional claims data. Enter – LexisNexis® Socioeconomic Health Scores.
"Social determinants of health are the X factor," said Josh Schoeller, Vice President of Healthcare Markets at LexisNexis. The X factors includes things like social isolation or engagement, community life, economic stability, a person's neighborhood and surrounding environment, and education. In fee-for-service, a physician knowing this information was a good idea. Under value-based care, it's critical to the entire organization. Data is key.
The Centers for Medicare and Medicaid Services has started to talk about the need to use social determinants of health, Schoeller said. Keeping track of patients, however, is a challenge. Each year, 45 million people move, three million change marital status and 21 million change their employment status.4 Eleven percent of consumers enrolling in the healthcare exchanges have no claims history.5
Patients often have more than one medical record, so that a provider has no idea, Schoeller said, that the person sitting in their office has had two procedures done already. This gets costly. Just the price of a duplicate medical record can be between $50 to $96. "The healthcare landscape is constantly changing and so are identities," he said. "It's very critical to keep information up-to-date." Most healthcare organizations were built to either coordinate or deliver care – not manage data.
LexisNexis began thinking about how to optimize the ability to match members to existing claims records. To do this, systems need to understand nicknames of patients, their historical addresses and other information. "How do you know if you keep identifying the same person?" Schoeller said. "Deliver intuitive marketing attributes that generate a deeper identity profile for target audiences."
LexisNexis recently partnered with an organization that provides consumers with an online and mobile platform through which they can receive information to help the consumer better manage their health. LexisNexis will leverage its identity authentication capabilities, social determinants of health data and analytics to provide intelligent insights that impact how consumers approach their overall health state. For example, the real age test is part of the app and it asks for your age. You may say its 42 but if the program tells you its 44 based on all the information analyzed in the background, you'd better go to the gym more, Josh joked.
The app is based on information from hundreds and hundreds of cohorts, or segments, and leverages member intelligence to improve healthcare. It can pull up information on who is using, and who is taking, their medication. "We do core data management to a unique individual," Schoeller said.
Once the data is aggregated, it becomes a useful tool in looking at encounters by segments of age and gender, family history, and those social determinants. It's real-time eligibility validation, dynamic segmentation enabling relevant content, secure and compliant access, enhanced risk assessment and engagement insights.
LexisNexis creates the data warehouse that's critical to manage members' identities from enrollment to encounter. It's the back-end of management that systems can use on the front end. "You start to be able to create analytics that's a better assessment," Schoeller said. "In relation to identity, how can you drive outcome insights if you can't identify unique identity?"
- Office of Disease Prevention and Health Promotion. https://www.healthypeople.gov/
- Cleveland Heart Lab. "Loneliness as a Risk Factor for Heart Disease and Stroke," May 9, 2016. http://www.clevelandheartlab.com/blog/loneliness-risk-factor-heart-disease-stroke/
- The American Institute of Stress. "America's #1 Health Problem." https://www.stress.org/americas-1-health-problem/
- Centers for Medicare & Medicaid Services. https://www.cms.gov/
- Forbes. "Coverage Expansion Fail: Less Than One-Third of Obamacare Exchange Enrollees Were Previously Uninsured." https://www.forbes.com/sites/theapothecary/2014/01/18/coverage-expansion-fail-less-than-one-third-of-obamacare-exchange-enrollees-were-previously-uninsured/#2abafcc04e7f
About the Author:
Josh Schoeller, Vice President, Healthcare Markets
LexisNexis Health Care