It’s time we looked at the big picture to improve healthcare
By Dr. Shantanu Agrawal, Chief Health Officer, Elevance Health
November 17, 2023
James Bastel slept in tents and in the parks of Council Bluffs, Ohio, when he experienced homelessness. He didn’t eat regularly and wasn’t able to consistently take his medications. He didn’t have a relationship with a doctor or a clinic, so health concerns required repeated emergency room visits and hospitalizations. It was a familiar and unwanted cycle for James—one that might have continued because of health-related social needs.
That cycle changed for the better when Tina, an Elevance Health case manager, contacted James while he was in the hospital. She helped him get the supports he needed as well as behavioral health treatment. What worked to get James on a healthier path sheds light on how the health system could work better for all of us.
Everyone should have the chance to be as healthy as they can be, which benefits individuals as well as society. Sometimes unmet health-related social needs and behavioral health needs stand in the way of physical health. We believe in this concept so strongly that we have grounded our health company’s business and health strategy around it.
A business grounded in a whole-health approach
Only around 20 percent of health outcomes and associated costs are tied to traditional physical healthcare needs, such as treating high blood pressure in a health clinic.[1] The other 80 percent are largely driven by unmet health-related social and behavioral health needs, such as lack of nutritious food, stable housing, social support or means to access care.
About 75 percent of the people who are members of Elevance Health-affiliated Medicaid health plans have multiple health-related social needs, and each unmet need drives up their healthcare costs by about $1,500 per year. Importantly, this detracts from their health and overall well-being because these health-related social needs are highly associated with anxiety and depression, emergency department use, preventable hospitalization and more unhealthy days (as defined by the Centers for Disease Control and Prevention).[2]
These are just a few reasons why Elevance Health has shifted our health strategy to focus on addressing a person’s whole health—the physical, behavioral and social health of all members. Data allows us to see which aspects of these primary health drivers offer the greatest opportunity to improve the health of the people and communities we serve. We can then help facilitate access to the needed resources to address those drivers.
Providing doulas, nutritious food and better medical care in rural areas
For example, an increasing percentage of pregnant women are not able to access care providers and may have living and working conditions that present barriers to regular prenatal care, leading to adverse health outcomes for themselves and their babies.[1] So we’ve included access to doulas in our Medicaid programs.[2] The result is that women have fewer inpatient hospital admissions during pregnancy, are more likely to attend their postnatal visit, experience lower odds of cesarean delivery, have lower odds of postpartum depression or anxiety and have lower overall costs compared to women not using doulas.[3] Data shows some women, especially Black and Hispanic/Latino women, feel they are treated better and more holistically when doulas are present.[4]
A lack of consistent access to nutritious food is a barrier to good health for millions of people. In a 2021 survey, Elevance Health found that 50 percent of those surveyed said it was hard to find affordable, nutritious food in their local communities. We financially support community-based food-distribution programs that improve access to nutritious meals, a key factor in managing ongoing conditions like diabetes, asthma, high cholesterol and hypertension.
Many people who live in rural areas across the country are not able to visit care providers in person due to geographical distance. About 45 million people in the United States, or 15 percent of the population, live in areas designated as health professional shortage areas (HPSA) by the federal government.[5] By partnering with community-based organizations and providers, we are working to make more care providers available through telehealth and mobile services.
We also created Community Connected Care, which seeks to assess and address health-related social needs by collaborating with community-based organizations (CBOs), such as food banks and other non-profits like area agencies on aging, centers for independent living and Boys & Girls Clubs. This means we create partnerships with CBOs to provide needed infrastructure support and resources that build capacity through a managed care approach.
In one partnership that spans 21 states, for example, we’ve been able to reinvest more than 60 cents of every dollar our health plan spent on the program into the community-based organizations that are serving our members.
- In one year, we have referred more than 200,000 members to offer solutions spanning community resources, health plan products and benefits, or customized interventions.
- Today, this program is available to individuals in the 14 states where we offer plans under the Affordable Care Act. Our data shows that 30 percent of these members have multiple unmet health-related social needs.
- By 2024, this program will be available to many of our Medicare plans.
- The program is financially sustainable because over time it focuses on prevention as a priority, replacing and lowering other healthcare costs.
Supporting whole health can improve health outcomes as well as the bottom line. Considering and acting on all the drivers of health—looking at the bigger picture—that contribute to a person’s health is not just the right thing to do. It’s the right thing to do for our members, our business and the health system.
Sources
[1] https://nam.edu/social-determinants-of-health-101-for-health-care-five-plus-five/
[2] Elevance Health Social Risk Survey Data.
[3] https://www.marchofdimes.org/about/news/new-march-dimes-research-shows-access-to-maternity-care-worsening-millions-women-us
[4] https://www.elevancehealth.com/our-approach-to-health/whole-health/the-evidence-is-there-doulas-improve-maternal-health-outcomes
[5] https://www.elevancehealth.com/public-policy-institute/addressing-maternal-health-disparities-in-medicaid
[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9796025/
[7] https://www.cdc.gov/ruralhealth/about.html
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