How social interventions and collaboration are solving health care’s persistent challenges

More than a decade after the triple aim framework for improving health care caught on, stakeholders across the health care system are still working to transform the experience of health care and health outcomes at a manageable cost.

Though the system is complex, one of the primary reasons this has been such an uphill battle is that health is heavily influenced by factors that exist well outside that system.  Access to healthful foods.  Access to transportation to the doctor's office, the pharmacy, the grocery store.  Social support.  Income, education, health literacy.  The list goes on.

Fortunately, data, technology and collaboration are enabling development of new tools to address these factors, the social determinants of health.  As stakeholders unlock solutions, health insurance providers, health systems, physicians and – most important – patients themselves stand to benefit.

To learn more about the progress and promise of efforts to address social determinants, SmartBrief spoke with Matt Eyles, president and CEO of America’s Health Insurance Plans, who took us on a deep dive into the issue.  AHIP has focused heavily on advocacy and education in this space, and it continues to share the work and expertise of members and their community partners. 

Social determinants of health has easily been one of the most talked-about topics in health care over the past year or two. But is it really a new focus for health insurance providers?


AHIP President and CEO Matt Eyles

The subject of social determinants of health has reached a much higher level of consciousness among so many health care organizations, stakeholders, and others who want to improve the health of Americans. Health insurance providers have known for quite some time that not every health care problem can – or should – be addressed with a prescription pad. For several years, they have focused on how to address social barriers to good health, as part of their commitment to whole-person, patient-centered care.

Health insurance providers believe it’s up to all of us to create social and physical environments that promote better health for everyone. And the new attention being paid to this subject has energized the entire health care ecosystem to consider how we can better work together to improve the health of people, families and communities.

Medicaid managed care programs have been an important source of insight on social determinants. Are insurance providers in other spaces able to adapt and apply these lessons?

Medicaid has been an important area for addressing social barriers because of the diverse and often medically vulnerable populations it serves. People who rely on Medicaid include children, older adults, people with disabilities and millions of veterans.

There are unique challenges that need to be overcome in Medicaid. For example, due to challenges with affordable housing, some people may be difficult to physically locate because they move frequently from one location to another. Some may not have ready access to technology. They may have highly complex health care needs or need assistance with activities of daily living. But Medicaid managed care organizations are creative, and they have been problem-solving for some time. Their approaches are as different and customized as the states they serve.

And once a program shows real results, managed care organizations quickly work to see what lessons can be learned and adapted to help people covered by Medicare or other health insurance programs or living in other states.

Can you discuss some of the variation in important social determinants for different populations?

Studies have shown that more than 70% of a person’s health can be linked to factors other than medical care. Some social barriers are fairly consistent between populations, such as a lack of access to healthy food, a lack of transportation to the pharmacy or doctor, and insecure housing. Health insurance providers can often connect people to services to help them, such as SNAP (nutrition) benefits, community transportation services, or HUD (housing choice) vouchers. Several insurance providers also launched their own groundbreaking programs in communities that can be most helped by them – and they’re seeing real results.

There are other barriers that disproportionately affect a specific population. For example, older people are found to suffer more from social isolation – which is why some health insurance providers like Cigna, Anthem/CareMore, Cambia and others have programs that directly target loneliness.

But even if the barriers generally are the same, the ways to address them will always be different and local. Different communities have different needs – and solutions need to consider those differences. It takes several organizations and people coming together in a community to take care of each other. And health insurance providers are often found working hand-in-hand with community leaders to create sustainable solutions that help people get healthier faster, and stay healthier longer.

To what extent is the new flexibility for coverage of social interventions sparking innovation in Medicare Advantage?

This new flexibility is terrific, and the CMS should be commended for its efforts. Flexible benefit designs allow insurance providers to offer more comprehensive benefits and services to seniors, drive down costs, improve health outcomes for patients and ensure efficient and effective care coordination. The CMS has recognized that people with chronic conditions need programs that may help improve their health, as well as their ability to manage their chronic conditions.Giving health insurance providers more flexibility to tailor benefits and services to patients with chronic disease is likely to improve outcomes over time.

Some social determinants are presumably less complex than others to understand and address. Where have plans started to crack the code, and where are they still in the learning phase?

Health insurance providers are focused on whole person care, which includes understanding both the health and social needs people have. Then it requires coordinating and collaborating with community-based organizations and public partners to address the social needs. This is perhaps the most important lesson we have learned over the past several years. We see the most success when insurance providers are able to connect a member in need with community-based resources that specialize in providing that type of services or care.

Successful programs focus on identifying the population you are trying to reach, connecting those people with a community-based resource where they can get support, establishing a process for referring and tracking these kinds of services, and defining metrics to measure impact.

Some of the best examples of success can be found in AHIP’s reports on food insecurity and housing.

Are you hearing much about the response to social determinants interventions?

Health insurance providers find that their members and patients are grateful for the support. Often, getting to the doctor wasn’t just about finding the right provider and scheduling the visit – it was about finding transportation and finding a cost-effective way to get to the appointment. Health insurance providers are continually looking for innovative ways to make it easier for patients to access the right care at the right time. Achievement of this goal not only improves the care experience for the patient, but it improves outcomes and reduces costs for the whole health care system.

Health insurance providers are driven to keep people healthy, because when they do better, we all do better. By applying what we know about social determinants of health, we can not only improve personal and community health, we can advance health equity and improve people’s peace of mind. People’s health improves. Coverage and care costs go down. Families and communities are stronger. These commitments drive us to find new and better ways to care for the people we serve.

Matt Eyles is president and CEO of America’s Health Insurance Plans, the national trade association representing health insurance providers. He joined AHIP in 2015 and led its Policy & Regulatory Affairs team, and he was chief operating officer before his appointment as president and CEO. Matt has more than two decades of health care experience in the private sector and in government, including roles in public policy, government affairs, advocacy and corporate communications. Before joining AHIP, Matt held senior executive positions at Coventry Health Care (now an Aetna company) and Wyeth (now a subsidiary of Pfizer). Through his work at Avalere Health, he has been a consultant to some of the largest global and US health care companies and organizations. Matt began his career at the Congressional Budget Office, where he worked on many issues, including health care, budget policy, and regulatory policy.

Melissa Turner is director of health care and life sciences content at SmartBrief. She edits science, medical and health care delivery newsletters, including AHIP Solutions SmartBrief, and she oversees development of content marketing pieces for SmartBrief’s health care clients. Check out all of SmartBrief’s health care newsletters, covering health IT, news for insurers, news for providers and more.