The COVID pandemic changed the landscape of the social needs that drive health overnight. Millions of people lost their jobs; millions of people were ordered to stay home. People lost access to food for themselves and their families because they couldn’t afford it, or they couldn’t get to a grocery store. Miles of cars waiting at drive-through food pantries dominated the headlines. People became more isolated and depressed. People’s ability to pay for their housing was jeopardized.
This brief describes how three organizations already versed in addressing social drivers of health pivoted fast to respond to this enormous increase in social needs. Within weeks, leaders from Humana, UnitedHealthcare, and Second Harvest Heartland redesigned – in some cases radically, in other cases incrementally – their member interactions, programs, and operations. While very different in many ways, these organizations are pursuing a common mission and have developed similar strategies to fulfill it – historically, and during this crisis.
Humana’s “Bold Goal” program collaborates with social service organizations in 16 communities to address food insecurity and loneliness. Second Harvest Heartland’s “FOODRx” program in Minnesota works with health care payors and providers to provide home-delivered “medically tailored” food boxes to people with chronic conditions. It also connects them to other vital food resources and assists with SNAP (food stamps). UnitedHealthcare’s “Accountable Health Communities” program in Hawaii works with hospitals and health centers to screen patients for social risk factors and refer them to community resources.
In a forum sponsored by Harvard Kennedy School in June 2020, the programs’ leaders outlined what they did, what they learned, and how they expect their programs to evolve. In a word, they had to pivot – not once, but several times – to meet their patients’ needs. In a compressed timeframe, emergency response evolved into more systematic program modifications as these organizations learned more about what their members needed.
The three programs’ strategies and responses followed similar paths. In addition, all three leveraged the relationships, tools, and skills they had refined since the inception of their programs.
Existing programs were modified to meet immediate needs. All three organizations quickly expanded and modified their food distribution to meet enormous surges in demand. FOODRx began delivering nutritious food boxes to homebound seniors and developed partnerships with transportation vendors to take people to the grocery store and/or food shelves. Humana set up drive-through sites in stadiums and parking lots. In addition, Humana redirected the volunteers who were visiting older adults to combat social isolation to do their grocery shopping.
Virtual communication replaced in-person visits. All three programs screen patients for social risk factors like food insecurity. They quickly transitioned to phone and other virtual communications – similar to providers’ massive shift to telehealth. Humana created a proactive outreach team to contact their high-risk members. The care coordinators at FOODRx’s health care partners added questions about food insecurity to their conversations with patients. UnitedHealthcare’s social service partners figured out how to help people fill out SNAP applications using virtual communication tools.
Formal and informal data analysis identified the greatest needs. All three programs drew on their established data sources – including patient screening results, health records, call center statistics, and anecdotal information from the field – to figure out where demand for services was growing and where the unmet needs were greatest. � For example, UnitedHealthcare added new questions about COVID-related support to its screening questionnaire. They also used the aggregate screening results to understand how needs for food, housing, transportation, and other services were changing.
The crisis inspired rapid response and decision-making. All three programs highlighted the speed and agility of their organizations and partners. Decisions that would usually take months were made in weeks – to modify programs, set up new communication channels, redirect staff and volunteers, and increase funding. Everyone pitched in regardless of title or job description. These programs already operated in an agile “test and learn” mode -- a strong foundation to move quickly and effectively to meet unprecedented needs.
Future directions. These programs gained new insights into their members’ needs and the options to meet them where they are. Going forward, they expect to sustain innovations like virtual visits and grocery delivery to homebound older adults. In addition, they expect to study the impact of their COVID responses on the extraordinary needs they were designed to meet.
About the author
Alexandra Schweitzer specializes in the design, development, and leadership of integrated health care payment and delivery systems, including programs to address social drivers of health. Recent highlights of her work as an organizational leader and consultant include building and serving as Executive Director for a five-star Senior Care Options program for dual-eligible seniors; and collaborating on the design, implementation, growth, and SDOH strategies of two Medicaid ACOs.
Alexandra is a Senior Fellow at the Mossavar-Rahmani Center for Business and Government at Harvard Kennedy School. Bridging her leadership experience and academic rigor, her research focuses on success strategies for programs to address social drivers of health. She welcomes contact at aschweitzer@hks.harvard.edu.
Alexandra has served on numerous non-profit boards in senior living and home care. She is currently Board Chair of Goddard House Assisted Living. As a member of the LeadingAge Massachusetts board, she founded an innovative Housing + Health Integration workgroup.
Alexandra has a Master’s in Public Policy from Harvard Kennedy School, an executive MBA from Columbia University, and a BA in English and American Literature from Brandeis University. 