Community-based interventions can be a powerful asset in tackling health issues and behavioral change. Not only can they drive better outcomes, but they can improve health equity and access to care for lower-income communities.
Social determinants of health (SDoH) are gaining attention due to their impact on improving a person's well-being and lowering health care costs, with payers, providers, and regulators taking note. SDoH are defined as the behaviors and conditions in places where people live, learn, work, and play such as housing, food insecurity, education, transportation, and loneliness—that affect a wide range of health and quality of life factors.1 They contribute up to 30 percent to 80 percent of variation health outcomes and disproportionately affect the Medicaid population.2
Community-based interventions can be a powerful asset in tackling health issues and behavioral change. Not only can they drive better outcomes, but they can improve health equity and access to care for lower-income communities.
Overuse of emergency departments happens for a variety of reasons. It can be due to lack of transportation, transient housing issues, confusion with medication, or lack of engagement with a primary care physician or specialist. Inappropriate utilization of emergency departments accounts for $8.3 billion per year and it is associated with poorer health outcomes.3
By creating peer-to-peer social communities and connections, individuals can obtain information on preventive care and its importance. In addition, these trusted communities can influence individuals to appropriately change their health behaviors and patterns, creating an environment that allows them a level of comfort to engage with credible information sources to inform, address, or tackle the barriers to obtaining care and address reasons for ED overuse.
In a retrospective propensity-matched cohort study, inappropriate ED use was compared between two observed groups. For those individuals exposed to a community-based organization, Wider Circle, a reduced ED use of 45.7 percent was observed, vs. an increase of 12.1 percent 
in the control group. These peer-to-peer models of managed care help tackle hard-to-reach Medicaid populations at scale, targeting members with complex social issues and addressing health access and inequity in a trusted, culturally competent setting. Understanding this study and community-first models is a path to enabling individuals to become happier, healthier patients who take more control of their health, and spend less time inappropriately in the ED.
References
1 Centers for Medicaid and Medicare Services. Press Release: CMS Issues New Roadmap for States to Address the Social Determinants of Health to Improve Outcomes, Lower Costs, Support State Value-Based Care Strategies. (2021). Retrieved July 15, 2022, from https://www.cms.gov/newsroom/press-releases/cms-issues-new-roadmap-states-address-social-determinants-health-improveoutcomes-lower-costs
2 University of Wisconsin Population Health Institute. County Health Rankings Model. Retrieved June 15, 2022, from https://www.countyhealthrankings.org/explore-health-rankings/measures-data-sources/county-health-rankings-model.
3 Daily R. Preventable ED Use Costs $8.3 Billion Annually: Analysis. (2019). Retrieved July 19, 2022, from https://www.hfma.org/topics/news/2019/02/63247.html
About the author
Claude Pinnock, M.D., MPH, chief medical officer, Wider Circle, is a health care industry veteran with deep clinical strategy and digital health experience and brings a strong passion for improving access and quality to -elevate health for all with a focus on social determinants of health (SDoH).
Dr. Pinnock is responsible for crafting, directing, and overseeing the execution of Wider Circle’s clinical strategy for expanding its Medicare and Medicaid business. In addition, he leads research, business development, and supports the senior leadership team in their efforts to further shape and grow the organization, including collaborating closely with Wider Circle’s product development, marketing, and sales teams.
Dr. Pinnock began his clinical career in the United Kingdom, earning his Bachelor of Medicine, Bachelor of Surgery (BMBS) at the University of Nottingham and his master’s in public health from Cambridge University. While he began his career as a practicing physician in rural Cambridgeshire, a personal interest in driving the adoption of value-based healthcare in EMEA eventually led to a position at International Consortium for Health Outcomes Measurement (ICHOM). Following a move to the United States, he held leadership positions addressing service redesign, quality improvement, and strategy in public and private health sectors (Stanford University School of Medicine, Clarify Health Solutions). Most recently, he managed global strategic partnerships in health at Meta, Facebook’s parent company, and led their health partnerships innovation team driving global adoption of vaccines.