Social risk factors are the adverse social conditions associated with poor health and health-related outcomes. Food insecurity, ethnicity, limited community resources, and poverty are social risk factors that play a major role in health. Significant gaps remain in health and life expectancy based on poverty, race, ethnicity, and community environment. Patient-centered care and understanding their social needs are crucial to improving the quality and efficiency of healthcare.

Fortunately, the growing recognition of the impact of social risk factors and the movement of the healthcare system towards value-based payment models means there is an opportunity to improve care quality, beneficiary outcomes, and reimbursement. Health plans are well-positioned to identify social risk factors and unmet social needs and play an important role in addressing and mitigating them. To progress efforts toward achieving health equity and the provision of high-quality care for all beneficiaries, the National Committee for Quality Assurance (NCQA) has proposed a new HEDIS measure that would focus more closely on addressing health-related social needs.

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Social needs screening and intervention

Health plans, providers, and other health system entities have recognized the importance of measuring factors that go beyond typical clinical operations and outcomes. As social, economic, and environmental determinants impact health and health-related outcomes, there is a need for more widely adopted and consistent documentation to track progress towards addressing them. To address health inequity, the Centers for Medicare and Medicaid Services (CMS) has included proposals in the 2023 Proposed Rule and Rate Notice to incentivize social needs screening and intervention.

The proposed new measure for HEDIS Measurement Year (MY) 2023, Social Need Screening and Intervention (SNS-E), will assess whether a contract’s enrollees have had their health-related social needs (HRSNs) assessed using a standardized screening tool [1]. The measure will look at the percentage of screened beneficiaries at least once during the measurement period. Health plans would be rated on whether they screened for unmet food, housing, and transportation needs and given a corresponding intervention if screened positive. This measure is part of the NCQA’s greater efforts to improve health equity and increase accountability among health plans to evaluate and address social determinants of health for beneficiaries. As there is no national health plan measure to determine and address social needs, prioritizing this measure will help fill the existing gap.

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Integrating health-related social need data into clinical care is recognized as a driver for improving healthcare. Identifying the social risk factors that beneficiaries face enables health plans to provide the appropriate interventions to connect them to the quality care they need. LetsGetChecked’s at-home healthcare solutions can help Medicare and Medicaid beneficiaries overcome their health-related social needs by meeting them where they are. Our virtual solutions enable patients to test from the comfort of their homes, enabling them to overcome barriers to healthcare access such as transportation.

With convenient at-home testing, beneficiaries can avoid rescheduling or missing appointments and delaying care, while health plans can identify risks that may otherwise go unnoticed and result in more high-cost chronic conditions down the road. Health plans who continue to prioritize addressing health-related social needs by improving their member offerings and engagement, will not only increase revenues but also gain an advantage in attracting new enrollees and continuously improve quality.

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