It is no secret that healthcare in the U.S. has major issues. Millions lack access to insurance, and healthcare expenditures continue to rise decade after decade. In fact, healthcare expenditures now represent 18% of America’s GDP. Because of this, government policies pursue changes that provide reimbursement incentives for better outcomes rather than the services performed. These changes have already begun to affect how hospitals and providers are providing patient care. But in regards to the social determinants of health (SDOH), much broader change is needed. This is what Dr. Jamo Rubin (Founder and CEO) and TAVHealth hope to achieve.
The Impact of the Social Determinants of Health
What are the social determinants of health? In short, the social determinants of health involve factors that typically exist outside of healthcare systems that affect our well-being. For example, being employed and having an income is one of the social determinants of health. Lower income leads to poor health outcomes.
Adequate transportation is also one of the social determinants of health. Many rural residents struggle to make doctor’s appointments because of a lack of adequate transportation options. Poor access to food, clean water, and housing are also well-recognized as factors.
Social factors naturally predict health outcomes. But the social determinants of health have yet to be effectively addressed by the healthcare community. Accountable Care Organizations have pursued some programs. For example, some have addressed hunger, while others are examining social supports for substance abuse disorders and homelessness. But much more needs to be done.
With this in mind, I had the opportunity to discuss the impact of the social determinants of health with Jamo Rubin, MD, founder and CEO of TAVHealth, and Spencer Magloff, TAVHealth’s Marketing Director.
John R. Miles: As you are aware, Bold Business has written a number of articles on the Social Determinants of Health. Why are the social determinants of health important for healthcare systems today?
Dr. Jamo Rubin: The health of any society relies on not just on sick care, but also how to maintain health. Certainly, the disease is a driver of sickness. But social determinants of health are also a significant root cause of illness when poorly controlled, especially in vulnerable populations. Why does this matter? In the next seven to ten years, one in three Americans will be on Medicaid. Likewise, one in four will be on Medicare.
That means the government will fund over half of the nation’s healthcare. So, the government will increasingly be searching for ways to keep people healthy and ultimately reduce their costs. Addressing the social determinants of health, which exist upstream from the healthcare system, offers an important part of the solution.
For state budgets, the problem is even more acute. State healthcare spending on Medicaid is often the largest line item for a state’s budget. That includes all states! As Medicaid enrollment continues to grow, so will this financial burden. This will require some sort of shift in the way that states manage this cost. The choices are few for states. They can either pay less for healthcare, create innovative healthcare models, deny services, or start addressing social determinants of health.
JRM: With that backdrop, what role does the social determinants of health play in promoting better health and health equality?
Rubin: Healthcare systems are responding to the changing payment incentives. They are moving away from activity-based reimbursement to outcomes-based reimbursement, with significant improvements in clinical care delivery. By weaving in “social care” to their clinical care plans, hospitals can advance healthcare quality much further. The good news for health systems is that community-based organizations are already doing this work. All that’s needed is formal collaborations and alliances between health systems and community partners. This provides the opportunity to create what some call “whole person care,” not just “sick care.”
JRM: You are a prominent and talented cardiac transplant anesthesiologist. What was the genesis of your founding TAVHealth and changing career direction?
Rubin: This is the third company in which I have been involved. The first company, Medical Present Value, helped physicians and hospitals better understand the payment system and monitor payment accuracy. It was eventually acquired by Experian. The second company, PTRX, helped manage pharmacy benefits. The company focused on finding ways to help people find alternative medications when those prescribed were unaffordable. It was eventually sold to United Healthcare. TAVHealth was formed subsequently after expanding on some of the insights gained from each of these companies.
For example, we learned the most common reason people didn’t take their medications wasn’t “behavioral.” Instead, it was because they couldn’t afford them and didn’t know how to approach their physician. In other words, it was really a financial problem, not a clinical problem. It was my first real insight into the importance of the social determinants of health as a physician. These represented key elements in whether or not patients could adhere to a care plan that had nothing to do with the healthcare system. Likewise, if someone couldn’t afford their medication, they probably couldn’t afford other things in their life as well. For instance, they might also be unable to afford transportation to a medical appointment.
JRM: What was the Bold idea behind TAVHealth and the problem you were trying to solve?
Rubin: About ten years ago, CMS started adopting value-based payments as a way to rein in costs. In other words, CMS started paying more for outcomes and less for activity. CMS is the largest buyer of healthcare in the U.S. Therefore, this fundamental change in incentives was expected to cause a shift in how the healthcare system would operate. For TAVHealth, we suspected that healthcare providers would have to solve not only clinical problems but social problems as well. In fact, our bet was the shift to outcomes-based reimbursement would require addressing social determinants of health. But the means to follow people over time to ensure they got the help they needed didn’t exist yet.
With healthcare being the largest U.S. industry with $3.5 trillion flowing through the economy annually, the opportunity seemed tremendous. And likewise, the issue seemed like an important one for us as a country to solve.
JRM: What makes the TAVHealth approach different?
Rubin: Currently, payers and providers use case managers to follow people over time. They also keep digital registries of community services for patients. But despite these efforts, they are not well equipped to deal with the life circumstances that patients experience. Nor are they able to systematically measure the impact of social services on the cost and quality of healthcare.
Unlike resource directories or basic referral platforms, TAVHealth offers a way to follow people over time in the community. At the same time, TAVHealth allows for the creation of longitudinal social records of these individuals. These longitudinal social records can be merged with clinical records. This approach provides a more comprehensive view of all services someone may need as well as their outcomes after receiving these services. Which makes it possible to measure what outcomes are generated when these social and clinical services are provided.
Additionally, TAVHealth is unique in its ability to model how state and federal privacy laws protect a person’s confidential information. Embedding privacy rules into a platform allows for safe sharing across community and clinical organizations. This provides the means for the right people to see the right information at the right time. That’s different. No other company in our space has figured out how to do that. And it’s a requirement to measure outcomes over time.
JRM: What is the impact of addressing social determinants of health to patient care and the patient themselves?
Spencer Magloff: Prior to TAVHealth, patients or providers would pick up a phone and call a community organization. However, there was no way to know what happened after their visit or even if they had visited the organization. Was the service used? Did the patient receive the resources they needed? Did the services help the patient have a better outcome? There was a huge disconnect.
TAVHealth provides a software platform with a privacy component that lets the entire healthcare ecosystem talk to one another. This allows a longitudinal social record to be built for each person as they navigate through healthcare organizations and community services. All of this information can now be documented and tracked in one place.
Ultimately, this allows that person to receive better healthcare. And it provides metrics related to the social determinants of health which can be linked to quality and financial performance data.
JRM: What have been the results thus far and what are the next big steps for TAHealth?
Rubin: CMS has identified Triple Aim Values (TAV) as the ultimate goal for healthcare. These seek to deliver better health outcomes at a lower cost within a better service experience. To date, healthcare has not been able to achieve all three, but this is TAVHealth’s ‘North Star.’ Hence our name, TAVHealth.
TAVHealth has repeatedly been able to tie activities to outcomes, and better health outcomes are leading to fewer healthcare expenditures. We document these outcomes on our website as case studies. From reduced emergency room use to fewer readmissions after hospitalizations, TAVHealth documents how solving social determinants generates better outcomes.
“Moving into 2019, TAVHealth will enjoy significant growth in the Medicaid and the Medicare Advantage space. At the same time, we will continue to service the hospital market. The quality, financial, and customer satisfaction impact for our client base will be tremendous.” – Rubin
TAVHealth’s Powerful Solutions to Addressing Social Determinants of Health
Many of the problems related to the U.S. healthcare system involve its complex and fragmented structure. Duplicate services lead to poor information sharing and access, as well as rising costs. Likewise, prior financial incentives are linked to the volume of services rather than desired health results. Healthcare policy changes address these issues. But these still fail in addressing the social determinants of health outside of healthcare systems that drive these results.
TAVHealth provides a solution by addressing the social determinants of health more effectively. Longitudinal social records of patients are created through TAVHealth’s software platform. This lets stakeholders track social needs, utilization of community services, and outcomes that tie back to the healthcare system. By enabling providers, payers and community services to access and share this information, better population health can be realized. Ultimately, this lowers healthcare costs while improving the nation’s health in total.
Consequently, TAVHealth offers a more holistic approach to healthcare and addressing social determinants of health. In the end, that means a healthier general public.