SDOH and Health Equity in 2023

If you’ve been keeping up with The Center for Medicare and Medicaid Innovation, or are employed by a health system, then you’ve likely seen the federal government’s new requirements in its ACO REACH payment model.

The new data collection requirement tells us that 2023 will be the year for walking the walk as far as health equity and SDOH (social determinants of health) are concerned. The Biden administration is pushing a much more holistic approach to healthcare by using data as the main driver.

In this blog, we’re going to dive into some key points to keep in mind as you begin planning your strategies and tech stack for 2023.

About health equity gaps and why they’re so important.

Everyone has a right to health and proper healthcare is a critical part of that. Health equity runs on the principle that everyone has a right to reach for their full health potential (1). In the United States, patient access can be affected by a lot of different things like location and economic status for example.

With gaps in wealth and income gradually increasing, this is heavily reflected in health equity because certain populations do not have the same access to quality healthcare. These gaps in care can cause unnecessary delays that end up costing both payers and providers a lot more in the end instead of taking preventative measures with active care.

While health systems and payers have been collecting SDOH data for a long time, now CMS is taking strides to address the underlying issues.

ACO REACH Payment Models and data collection.

It’s no secret that this year, the professional and global Direct Contracting Model is shifting to the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model.

The benefits of the ACO REACH Model for physicians and healthcare providers starts and ends with being able to receive more consistent and predictable revenue. Providers would have much more flexibility in how that revenue is spent in accordance with meeting their patient’s needs. This adds a layer of resiliency, especially now, while we are still feeling the ramifications of the COVID-19 pandemic (delays in care, less access to care, etc.).

In order to participate in the ACO REACH Model, which is voluntary, physicians and providers must meet certain criteria pertaining to health equity, like using their SDOH data to create a health equity plan for example. These health equity plans must be submitted early this year.

According to an article in Fierce Healthcare, the plan includes not only a requirement to collect data on social determinants of health for its patient population but also the development of measures to target these factors.

This is where the importance of data collection will play a starring role.

What data has to do with it.

For many years, health systems have been collecting SDOH data with the promise of creating a health equity plan based on their findings. Now, it’s time for providers that want to participate in the ACO REACH Model to walk the walk, essentially.

This is a highly individualized approach to value-based care as every health system, physician, and provider caters to different patient populations with different challenges. Many organizations are using their data to come up with a health equity plan for the most common challenges to healthcare access for their patient populations.

Examples would be colo-rectal screenings, diabetes prevention, and blood pressure management, access to care for rural populations, and being more proactive about transportation.

What about payers?

It shouldn’t come as a surprise that Payers are taking their own strides into health equity. Especially considering the astronomical hits that they experienced in 2021 and 2022 due to delays in care caused by the pandemic.

Some ways that they are doing this is by launching value-based contracts based on health equity and by exploring a much more holistic onboarding process for their insureds. This gives them special insights into why patients want to stay healthy and how the insurer can help them achieve those goals.

Health plans are in an especially beneficial position when it comes to health equity, as they get a bird’s eye view of different patient populations to determine who may need more preventive screenings or may not be properly maintaining their chronic conditions.

The growing pains will be worth it.

While the ACO REACH Model is different than what providers and payers may be used to, this model introduces holistic care and improved health equity for patient populations everywhere.

By utilizing SDOH data to create health equity plans, providers are able to participate in a revolutionary program that has the potential to change the face of healthcare in the United States for the better.