Health equity is generally defined as the ability for all people to achieve their full potential for health and well-being, free from avoidable disadvantages that limit their access and impact their outcomes. The concept of health equity means considering all of the social, economic and environmental factors that get in the way of a member’s ability to access equitable care, whether from a medical provider or a social services agency. So why, then, is “care” broadly understood as just medical appointments?
In order to address healthcare disparities and promote health equity, it is essential that health plans and the industry rethink how we define the word care. It must include access to not just medical appointments, but also the additional services that address the barriers to equitable healthcare. Travel assistance, community-based organization offerings, nutritional counseling and easy access to mental health services are just a few examples. As we’ve all witnessed, simply having these services available as benefits — but sitting idle in an obscure, printed or online directory — doesn’t address the need or increase equitable access. Especially for disadvantaged members, it’s critically important to proactively support them in accessing all of these services.
SDoH Referrals to Support Health Equity
The very definition of health equity indicates that care includes more than what medical doctors can provide. Behavioral health counselors and community-based organizations (CBOs) serve members in ways that address underlying social determinants of health (SDoH) that are holding members back — the nonmedical factors that influence health outcomes — from accessing the care they need.
A Medicaid plan sought to address social risk factors that are barriers to care by scheduling member appointments with agencies that support areas such as food insecurity, financial assistance, nutritional counseling, transportation, behavioral counseling, language services, housing, technology support and more. They employed care navigators — compassionate service representatives calling on behalf of the health plan — with the primary goals of reaching members, understanding their needs through engaging with them, identifying the right service and scheduling the member with the service(s) that addresses their SDoH barriers, all in one phone call. In addition, they’re working to get these members in to see their PCP and/or an appropriate specialist. What’s more, they send appointment reminders and follow up to ensure they kept their appointments. And then, care navigators continue to follow up with the members during a monthly check-in. And they do it again the next month, until the member is on a stable care plan, directed by their PCP.
To date, this plan has made nearly 20,000 referrals to more than 25 different social service agencies that address members’ SDoH needs. And they’ve noted that these members are “getting care they wouldn’t or even couldn’t have otherwise gotten” — now that feels like equitable access to care. Furthermore, the data shows that there is both a significant improvement in outcomes across all races AND a reduction in the disparity between races (in 2020 there was a 10% gap from the lowest outcomes to the highest and, in 2022 that difference dropped to just 5%).
Scheduling Medical Appointments to Support Health Equity
Of course, getting those disadvantaged members to the medical care they need is still a vital part of driving health equity and access, and ultimately better outcomes. That same health plan also connected more than 5,500 members to appropriate medical appointments including visits to convenient primary care providers who speak the member’s preferred language and preventive screenings for the most commonly skipped or delayed services.
By taking a holistic approach to “care” and improving access by scheduling members for both medical and social services, health plans can level the playing field and more effectively impact overall health outcomes.
When plans expand the definition of care from just doctors’ visits to include SDoH benefits — and work hard to ensure members gain access to those elements of care — they address the social, economic and environmental factors that affect health equity. That’s the path to truly addressing healthcare disparities and driving equitable access to care.
Written by Meghan Snyder
Meghan is a customer success rockstar who brings expertise in consulting at health plans and technology companies to ReferWell. She helps government-sponsored health plans efficiently get up and running with care navigation programs that impact member outcomes in a matter of weeks.