In 2016, Geisinger launched 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 healthcare system launched the program in an area with high rates of diabetes and food insecurity and has had promising results to date, including a greater impact on participants’ hemoglobin A1c levels than medication.
But Geisinger faced some early challenges as it grew and adjusted the program. In a virtual panel at MedCity INVEST Digital Health, Geisinger Vice President of Health Innovations Allison Hess and other executives shared what they learned from introducing programs to address social determinants of health.
For Hess, the greatest realization was that programs should be designed holistically and not individually address the overlapping needs of patients. Initially, Geisinger had started its Fresh Food Farmacy program and a separate program for patients with transportation needs, but quickly found that many of these people overlap.
“When we started this journey four years ago, we were naive and followed them one by one,” she said. “The reality is that in many of these situations, the people we provide these services to have more than just one social health factor.”
Geisinger enlisted community health workers as part of the program to support these other social determinants.
Hess and others also emphasized the importance of working with local community organizations. When Geisinger wanted to expand the program to a neighboring town, the food banks initially saw it as competition, although their support was needed for this work.
“It’s really important to iterate, to realize that not every program is transferable, and not every program arrives in the same way with a community,” she said. “It’s really important to understand what this community is like, not just from a patient perspective, but also to consider other community factors and the role community-based organizations play in this work.”
Dr. Andrew Renda, head of population health strategy at Humana, said the company is increasingly working with community-based organizations to meet patient social needs. For example, it could direct them to boards or programs in community centers. But when that happens, these programs may have less capacity to do other things.
“(Community-based organizations) have no traditional ways of monetizing their services,” he said. “We have to work with them and make them whole to keep the work going.”
Importance of data
While the mission behind these programs is clear, Renda and others stressed the importance of data in structuring programs and measuring their impact.
“We all believe in, we all believe the addressing (social determinants) is the right thing to do, but we need to be able to show the evidence and that it has an impact on health outcomes,” he said. “We have to scale the work and keep it going.”
He also recommended not creating all new programs from scratch, but rather integrating them into existing workflows. For example, as part of a value-based payment program or as an add-on to a Medicare Advantage plan.
Retrieving the data itself can be a challenge. Most EHRs do not have a specific method of reporting social determinants of health and the quality of the information can vary. While some organizations may conduct food insecurity or loneliness studies, census data and other external resources can also be used to get a better picture of communities in need of more support.
Lucille Accetta, senior vice president of product at CVS Health, said it was important to invest in a dedicated team that would look at the data as that is the foundation of a program. From then on, it’s just as important to get involved at the community level.
“We encourage individuals who are considering investing the resources to run this entire end-end component on the data and watch it run through to the end,” she said.
Speaking of data, health organizations looking to launch these programs should also be aware that the outcomes they seek may differ from those of their community partners or even their participants.
“For us, it’s not just healthcare that counts,” said Dr. Trenor Williams, Founder and CEO of Socially Determined. “If this is a prescription store, grocery store, or grocery program, understand that the metrics that matter to you may not be emergency utilization or total utility costs.”
For example, he cited efforts by ProMedica, a healthcare system in Ohio and Michigan that began opening financial centers with services that help people find work, reduce debt, and build credit.
At the end of the day, he emphasized that the work must be done in collaboration with communities, not in communities.
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