In 2016, Geisinger opened its Fresh Food Farmacy, a program that connects people with type 2 diabetes with fresh food weekly, social services and a care team to help them manage their health. The Pennsylvania-based health system started the program in an area that has high rates of diabetes and food insecurity, and so far, has seen promising results, including a bigger impact on participants’ hemoglobin A1c levels than medication.
But Geisinger had to work through some early challenges as it grew and adapted the program. In a virtual panel at MedCity INVEST Digital Health, Geisinger Vice President of Health Innovations Allison Hess and other leaders shared what they learned when they launched programs to address social determinants of health.
For Hess, the biggest takeaway was that programs should be designed holistically, addressing patients’ overlapping needs rather than one by one. At the beginning, Geisinger had launched its Fresh Food Farmacy program, and a separate program for patients with transportation needs, but quickly learned that many of those people overlapped.
“Where we were naive, when we started this journey four years ago, we were tracking them individually,” she said. “The reality is in many of these situations, the individuals we’re providing these services to don’t just have one social determinant of health.”
Geisinger brought in community health workers as part of the program to help support these other social determinants.
Hess and others also emphasized the importance of partnering with local community organizations. When Geisinger sought to expand the program to a neighboring city, food banks initially saw it as a competitor, even though their support was needed for this work.
“It’s really important to iterate, recognize not every program is transferable, and not every program is going to resonate with a community in the same way,” she said. “It’s really important to understand what that community looks like, not just from a patient standpoint, but you have to take into consideration other community factors, and the role community-based organizations play in this work.”
Dr. Andrew Renda, who leads population health strategy for Humana, said that the company is increasingly working with community-based organizations to address patients’ social needs. For example, it might refer them out to food banks or programs at community centers. But as that happens, those programs might have less capacity to address other things.
“(Community-based organizations) don’t have traditional ways to monetize their services,” he said. “We have to work with them and make them whole to sustain the work.”
Importance of data
Although the mission behind these programs is clear, Renda and others emphasized the importance of data in figuring out how to structure programs and measure their impact.
“We all believe in it, we all believe addressing (social determinants) is the right thing to do, but we’ve got to be able to show the proof points and that it has an impact on health outcomes,” he said. “We need to scale and sustain the work.”
He also recommended, instead of creating all new programs from scratch, integrating them into existing workflows. For example, making them a part of a value-based payment program, or a supplemental benefit for a Medicare Advantage Plan.
Getting the data itself can be challenging. Most EHRs don’t have a dedicated way of reporting social determinants of health, and the quality of information can vary. While some organizations might have screenings for food insecurity or loneliness, Census data and other outside resources can also be used to get a better picture of communities that need more support.
Lucille Accetta, CVS Health’s senior vice president of product, said it was important to invest in a dedicated team to look at the data, because that is the foundation of a program. From there, it’s just as important to engage at the community level.
“We encourage individuals who are thinking about this to invest in resources to execute on this whole end-end component with the data and follow all of the way through with execution,” she said.
Speaking of data, healthcare organizations looking to start these programs should also note that the outcomes they’re looking for might differ from their community partners, or even their participants.
“It’s not just as healthcare entities what matters to us,” said Dr. Trenor Williams, founder and CEO of Socially Determined. “If it’s a produce prescription store, a grocery store or a food program, understand that the metrics that matter to them might not be emergency utilization or total cost of care.”
For example, he pointed to efforts by ProMedica, a health system in Ohio and Michigan, that started opening financial opportunity centers with services to help people find jobs, reduce debt and build credit.
At the end of the day, he emphasized that the work needs to be done in conjunction with communities, not to communities.
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