Here’s how UnitedHealthcare, a health insurance plan with benefit programs for individuals and families, employers, and Medicare and Medicaid beneficiaries, leveraged social determinants of health (SDoH) programs to better meet member needs, improve Star ratings, and close quality and HEDIS® gaps.

Recognizing the significant impact social determinants have on member actions, decisions, and health outcomes, UnitedHealthcare embarked on an SDoH journey to identify social needs in members and increase participation in programs.

“Having to think about things like housing instability, food insecurity, transportation, it can take up a lot of mental energy and strain your ability to engage in your health and live your best life,” said Alexander Billioux, vice president, social determinants of health, UnitedHealthcare, during last week’s RISE National 2021 virtual event. It was also an opportunity for the health plan to focus on Star ratings and close quality and HEDIS gaps, he said. “Care gaps are really critical for both the member’s health journey but also for us as a plan to demonstrate our care management is providing value, so meeting these needs has a dual benefit for the plan ourselves and, most importantly, the member.”

UnitedHealthcare leveraged a variety of SDoH programs, some directly to members, others in partnership with providers, to learn more about their membership and how the health plan could best support them. The SDoH efforts include in-home visits, call centers, clinical teams, dual-enrollment, and referral management programs.  In-home visits generate some of the most insightful information, according to Billioux, noting the appointments offer an inside look at members’ environments, barriers they may face, and other health-related social needs that a brief screening questionnaire can’t uncover. The in-home visits also provide a comfortable environment for members to discuss sensitive topics related to their social needs.

Data collection, analytics is key

To collect and manage SDoH data on their membership, UnitedHealthcare partnered with Change Healthcare, a health care technology company that provides data and analytics solutions and services. The collaboration allowed the health plan to gather membership data using artificial intelligence (AI) as well as incoming referrals from programs, such as in-home visits. The data helped the plan identify members with social needs and then determine the appropriate outreach and SDoH program.

The dual-identification not only allowed UnitedHealthcare to find more members struggling with SDoH, but it also enhanced dual-eligible enrollment, member engagement, and retention, explained co-presenter Jim Bridges, senior vice president, government services, Change Healthcare. Indeed, he said, simply addressing the need of members made them much more receptive to discussions around their dual status.

“We found members tend to stay much longer, have much better retention, and a much better impression of their health plan once we’ve engaged them around their needs related to SDoH,” he said. “It’s one of those places where what’s good for the health plan and good for the member have perfectly lined up.”

UnitedHealthcare also relied on the company’s referral management system, which ensured that the health plan could close the loop and follow-up on whether the referred community resource was helpful to members.

Billioux said that since implementing the SDoH programs, UnitedHealthcare has conducted more than 1.8 million screenings in 2020 and identified approximately 30 percent of members who have a social need, with two-thirds of those individuals accepting referrals. The health plan, he said, continues to learn how to better leverage that information, identify members, and close gaps during the screening process.