Digital Health Companies and Social Determinants of Health — Trends

• Focus on Social Determinants of Health Will Continue to Grow
• What It Is
• Before the Covid-19 pandemic, companies addressing social determinants of health (SDOH) were emerging.
• As a consequence of the pandemic, interest in these companies is expected to continue growing, as the health crisis has highlighted the impact of SDOH in the overall healthcare landscape.
• In NYC specifically, 18% of surveyed healthcare business leaders believe SDOH will be prioritized in the upcoming year.

• Why It Is Important
• This represents a unique investment opportunity, not only for companies wanting to directly address these issues but also for companies focused on managing data related to SDOH.
• In addition, existing companies can also branch out and become part of this market. This is exactly what Uber did when it first launched its Uber Health initiative.
• Services like this one have expanded from patient transportation in non-emergencies to providing transportation for caregivers and families, and even taking patients to their scheduled flu shot.
• Other companies directly involved in the healthcare setting have also decided to expand and enter the SDOH market. MedBridge, a company focused on educational content is planning on including SDOH programs as part of its content in 2021.
• Expert Opinions
•  Jane Griffiths is an associate professor and the former chief nursing information officer at Dubai Healthcare Operation. She has stated that the impact of SDOH in the digital health market will go beyond companies.
• Griffiths said that "Social determinants of health will also, in the future, help us identify what influences the communities’ needs, determining not only health care requirements, but also urban and health infrastructure planning."
•  According to Dr. Toyin Ajayi, Co-Founder and Chief Health Officer of Citiblock Health "The importance of the social determinants of health, and the intersection of social, emotional, and physical care have never been more clear. Place-based and virtual care will shape the future of healthcare delivery."
• Healthcare Providers Will Adopt Standardized SDOH Data Collection
• What It Is
• It is expected that multiple players will be involved in addressing SDOH, which includes healthcare providers.
• In addition to providers, health systems such as Medicaid and Medicare as well as government programs are expected to become a more active part of this process in the wake of COVID-19.
• Accountable Care Organizations are incentivized by the Affordable Care Act (ACA) to address SDOH, which has made them more prone to adopting digital health solutions to do so.
• Why It Is Important
• This trend is already in play. According to a research study published in early 2020, approximately 917 hospitals in the United States were investing in programs addressing SDOH. The total investment of these programs amounted to $2.5 billion.
• According to Deloitte, health care organizations can seize this opportunity to address different SDOH. The firm sets Medicaid and Dual Eligibles as an example of organizations that can create more access points for patients. This access would involve access to care in a clinical setting as well as access to education, social services, and food.
• A report from NYC Health Business Leaders revealed that 8% of funding in digital health went to SDOH programs in 2020. This represents over $100 million. However, according to the report, larger investments are expected.
•  Frost & Sullivan established that by the end of 2020, SDOH data would be used to engage patients, assess risks, and decide on patient management by 40% of health systems. This prediction was made before the onset of the COVID-19 pandemic, meaning this number could be higher.
• Healthcare Providers Leaning into the Trend
•  Reading Hospital, in Pennsylvania has a team that has been collecting data on the SDOH relevant to their patients as well as looking for solutions to offer them.
• The hospital has partnered with data companies as well as social services to aid patients in connecting with solutions for their SDOH needs.
• An insurance provider, Central California Alliance for Health, has been developing programs addressing SDOH as well. This includes a nurse advise line that is available to all patients.
• According to their Quality and Performance Improvement Manager, Amit Karkhanis, further education regarding these programs will be a priority for 2021.
• Artificial Intelligence Will Be Used to Analyze and Segment Data
• What It Is
• Addressing SDOH involves collecting massive amounts of data that need to be analyzed and made easily available for it to have any practical value. Using Artificial Intelligence (AI) to do so is expected to be one of the strategies to manage these data.
• Different platforms can be used for this purpose, including using AI to extract information from Electronic Health Records (EHR) and making it readily available to healthcare providers and SDOH programs.
• Why It Is Important
• The use of AI could provide information not only to identify SDOH but also to assess results and estimate how these programs are impacting medical outcomes. Return on Investment metrics are needed for the continued development of these programs.
• The Center for Medicaid and Medicare Services (CMS) has started to implement AI for analytics processes in the context of SDOH. However, this is still a work in progress and a trend that will continue during 2021.
• An academic study published in January 2020 reported that by inputting socioeconomic information from patients, a machine-learning program was able to accurately predict the use of the emergency department and inpatient hospitalizations.
• This means that SDOH data alone could be used for risk prediction with the implementation of AI. This opens the door for preventive measures once the risk is identified.
• Companies Leaning Into the Trend and Expert Opinion
•  Jvion is a player in the clinical artificial intelligence market. In March 2020, it launched an analytics solution that uses demographic data to provide SDOH information to healthcare providers.
• In addition, the platform allows providers to identify disparities in care as well as to design community-level interventions based on this information. This was achieved through a collaboration with Microsoft Azure.
• Apixio is a healthcare technology outfit. Its senior vice president has remarked on the usefulness of implementing AI to address SDOH that "So much of that data collection can be resource intensive. AI (is) looking at scale to look at unstructured data, and then groom out the whole findings or factors related to social determinants."

Digital Health Companies and Social Determinants of Health — Partnerships and Use Cases

• Solera and Blue Cross Blue Shield
• Before the partnership started in March 2019, both organizations had been working on addressing SDOH at the community level. In the case of the BCBS Institute, to be able to provide plans that truly adapt to the needs of the members.
• The issues both organizations are looking to address are financial and food insecurity, fall prevention in the case of older patients, transportation issues, and social isolation, which is more prevalent now than ever.
• Since this partnership, different programs have been launched at numerous locations. One of these is Tobacco Cessation, which was launched with Blue Shield of California.
• The network providers of the program have shown successful results in prior cases, with quitting rates estimated at five to eight times higher than without this intervention.

• UVA Health Systems and Pieces
• In 2018, UVA Health Systems decided to partner with Pieces, a platform that would allow them to help patients connect with community organizations.
• The overall goal of this partnership was to obtain better patient outcomes. More specific goals focused on being able to follow the patient through their entire care journey, adapting technology to the needs of UVA Health Systems, investing according to the needs of the community, and creating a platform useful for the community.
• To do so, the company leveraged data from EHR, identifying SDOH as well as risk factors from these records with the use of AI.
• As a consequence, UVA Health Systems has been able to identify where the larger disparities are in the communities they tend to. This has also been applied during the COVID-19 pandemic, allowing the system to identify testing disparities as well.
• NowPow and Chicago Department of Health
•  NowPow is a community referral network, which has partnered with the Chicago Department of Health, serving the residents of the city of Chicago.
• The goal of this partnership is to help members of the community to access resources more easily as well as expanding the COVID-19 tracking effort.
• The solution offered to Chicago residents is easier connectivity with social services, including patients that are in social isolation due to COVID-19 infection or contact with an infected patient.
• An expected consequence is greater access to community resources. As Christina Anderson, deputy commissioner at the department of health stated "As the COVID-19 pandemic continues to unfold, it’s critical that residents know what supports are available and where to find them."
• Papa and Blue Cross Blue Shield of Kansas City
•  Papa Inc is a digital health platform focused on providing solutions for companionship of older adults as well as assistance. BCBS of Kansas City partnered with Papa to offer solutions to members of certain Medicare Advantage plans.
• The goal of this partnership is to address social isolation, which is a SDOH. In addition, there are also nutritional assistance solutions.
• The solution offered is the Pals platform, which connects seniors with students, young professionals, and stay-at-home partners. The members of these Medicare Advantage plans will be able to get 40 hours of this benefit in January 2021.
• According to the Vice President of Government Programs at BCBS KC, Lori Rund, the expectation is that they will be able to "offer seniors ongoing support and guidance as they take steps to live healthier and happier lives."

• Babyscripts and Aetna Health of Pennsylvania
•  Babyscripts connects pregnant women with their doctors through a virtual platform, while Aetna Health is a health insurance provider.
• These organizations partnered in November 2019 to provide solutions for Medicaid patients. The main goal of the partnership is to improve access to care in the case of expectant mothers.
• This solution addresses low-risk expectant mothers who can benefit from remote and virtual care.
• In addition, the platform is able to identify SDOH, information that can be used by the healthcare provider to assess the presence of additional risks.
• Furthermore, high-risk patients can also be monitored and their doctor can be notified of changes in vital signs to assess the need for them to go to the emergency.