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BCBS Institute and Solera partner, pay SDoH organizations through outcomes-based medical claims

The collaboration allows health plans to pay for healthcare-related social services delivered by community benefit organizations.

A new collaboration between Solera Health and the Blue Cross Blue Shield Institute addresses the social determinants of health through a combination of technology and a local ecosystem of community health resources to pay these organizations through outcomes-based medical claims.

The nationwide rollout of the Solera-BCBS partnership is planned for the second quarter of this year.

In the partnership, Arizona-based Solera manages all revenue cycle management functions for the health plan, submitting medical claims on behalf of the service provider.  It is handling patient identification and enrollment, reimbursement and payment.

WHY THIS MATTERS

Solera's technology allows traditionally grant-funded organizations to be paid through medical claims, like any other healthcare services provider, according  to Brenda Schmidt, CEO and founder of Solera Health.

The company  automatically determines when an individual meets a performance-based milestone or outcome metric.

This means that the SDoH organizations have a stable revenue stream, and that BCBS members in need of such services are getting their needs met,  with the goal to improve health and reduce costs.

Solera's "Match.com" technology platform can target recommendations to individual members for community resources for food, transportation and other services.

THE TREND

In one recent survey, 68 percent of Americans identified having concerns in at least one SDoH risk category, such as financial or food insecurity, social isolation, housing insecurity, addiction and transportation access.

Addressing such factors can improve patient health while leading to greater efficiency and healthcare savings. A 2018 study found an additional 10 percent reduction in healthcare costs, representing more than $2,400 in annual savings per person, for people who were successfully connected to community health programs and resources, compared to a control group of members who were not.

Meanwhile, fully 80 percent of payers believe that addressing the SDoH of their beneficiary populations improves their population health programs, according to a recent Change Healthcare survey.

For these reasons, entities are increasingly seeking innovative ways to address SDoH to help individuals access effective health resources.

ON THE RECORD

"Solera and the BCBS Institute expect an impact for all Americans by creating the ability for health plans to pay for healthcare-related social services delivered by community benefit organizations as an important part of value-based care," Schmidt said.

"The future of healthcare prevention moves away from the clinical setting into the community setting," said Blue Cross Blue Shield Association President Dr. Trent Haywood. "This transition means that food, fitness and transportation will become an integral component of how we evaluate holistic approaches to the health and well-being of our population."

Deirdre Fulton is communications professional and freelancer based in Maine.
On Twitter: @deirdrefulton

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