What Counts as Healthcare?

Sarah serves as a Senior Associate and has been largely focused on building leadership teams for high-growth Healthcare IT and Services clients including Health Leads, Accolade, Health Catalyst, Grand Rounds, The Chartis Group and Kit Check. She is currently on a tour of duty within Docent Health, the healthcare technology and services company that was built within Oxeon’s Venture Studio, backed by Bessemer, NEA and Maverick, where she serves as the Head of People & Talent. Sarah is deeply passionate about healthcare innovations focused on health equity and increasing access to value-based care. As I thought about how I would craft this quarter’s FWIW article on social determinants of health, CMS totally derailed my plan. I was going to start by hooking you with a lofty paragraph about my personal experience working as a clinical social worker in an under-resourced hospital in the Bronx. But then, CMS had to outshine me by announcing their $157 million innovation model focused on social determinants of health.

If you don’t mind, I’m going to tell you my lofty story anyway.

In 2011, I opened a yellow envelope that held my destiny - my internship destiny, that is. I soon found out that I would spend the next year of my clinical social work program at a hospital in the Bronx, rotating through nearly every unit in the hospital that spanned the lifecycle, from the neo-intensive care unit to hospice. During my year at this internship I learned two important things: 1) despite my expansive student loan debt, I had chosen one of the least lucrative fields imaginable, 2) (most importantly), there is a strong correlation - so striking, that it is visible to the untrained eye - between socio-economic status and quality of healthcare. Through my personal experience as an intern, as well as the research I soon dove into during grad school, I discovered that this under-resourced, inefficient, and uncoordinated hospital in the Bronx was the exact system positioned to serve the patients that needed resources, efficiency and coordination the most. For the first time, I caught a glimpse of the strong relationship between quality of healthcare and social standing.

You can only imagine my excitement when Oxeon began working with Health Leads – the leading organization moving to bring social determinants of health to the forefront. To put it mildly, I was giddy. Over the past year, we have partnered with Health Leads on their President, Chief Clinical Officer and Managing Principal, Strategic Partnerships & Innovation roles, and have been honored (to say the least) to support their innovative and relentless mission.

Research on social determinants of health (the conditions in which people are born, grow, live, work and age; shaped by the distribution of money, power and resources) is growing, and given its alignment with the incentives of value-based care, we are seeing health systems and healthcare leaders across the country begin to prioritize the integration of social and basic needs into their care settings. Scratch that – we are actually seeing health systems and healthcare leaders struggle as they try to figure out how to integrate social and basic needs into their care settings.

We’ve all known that social determinants are important in the context of healthcare, but for the first time ever, they are taking the main stage in the dialogue around the quality and cost conundrum. CMS’s $157 million, five-year investment in the first-ever innovation model focused on social determinants will focus on “building alignment between clinical and community-based services at the local level” and reducing healthcare costs by “providing intensive community service navigation” to meet patient needs. The connection between social needs and clinical outcomes has never been so clear.

In the healthcare IT and services space, we spend a lot of time thinking about how to solve the problems of a patient once they get into the healthcare system. There is a growing emphasis on starting this problem-solving process one-step earlier; before they enter the healthcare system. This begs the questions – where does healthcare start? And, what is the healthcare system responsible for solving?

Rebecca Onie, CEO of Health Leads, an organization that equips healthcare institutions with the knowledge, insights, and tools – screenings, workflows, training, analytics, customizable technology – to mobilize healthcare staff to work side-by-side with patients to access existing community resources, has spent her career thinking about these questions. As a leader in the social determinants of health movement, I sat down with Rebecca to get her insights into the social influences within healthcare, and how she and her team have thought through the process of minimizing inequalities and leveling the playing field for all patients. Rebecca commented,

The question around ‘what counts as healthcare’ is a big one. But the bigger question is, why have we chosen to draw the boundaries of healthcare where we have?, and how do we redefine those boundaries to make patients truly healthy? How do we redefine them to become boundaries that stand the test of time? People get overwhelmed by the idea of broadening our current construct of healthcare because it seems too overwhelming – we simply can’t carry the burden of being responsible for everything. But, the choice isn’t between our narrow definition of healthcare today and solving the war on poverty, it’s about finding the right sweet spot for the role healthcare institutions can play. The boundaries are simply too tight right now – why do we count diabetes and obesity under the healthcare umbrella, but not the challenge of having a refrigerator to store your insulin? Why do we know everything about our patients’ clinical comorbidities, but very little about their social comorbidities? We need to collectively find reasonable ways to assume more responsibility for these critical drivers of health.

“So”, I asked Rebecca – “what does this CMS announcement actually mean for the market?” She responded,

Being concerned about social and basic needs is no longer optional. It’s now widely recognized that just 10% of health outcomes are attributed to medical care, while 70% are tied to social and environmental factors and the behaviors influenced by them. The announcement from CMS is a huge market signal – they are acknowledging the connection between social needs and care delivery in a real way. Social needs are a key driver of quality and costs. The healthcare sector needs to be thinking about how we bring expertise around this to our teams. This is not about expertise in poor people – let’s be clear - this is about expertise in data, in quality improvement measures, in bringing real rigor and thoughtfulness around how we integrate addressing social needs into our workflows to drive impact on outcomes and cost.

As we redefine Oxeon as a healthcare growth services firm, our job is to not just track where healthcare is right now, but truly track where healthcare is going. Unfortunately, social determinants of health isn’t going anywhere, folks. It’s here to stay, and it’s here for us to solve.

As I think back on my wild and crazy year at that hospital in the Bronx, I imagine what would have been different if each of those patients I worked with were supported with basic and social needs – what if the elderly man that was deemed “non-adherent” to his medication because he couldn’t get a ride to a pharmacy, was connected to a transportation service? What if the twelve-year-old boy with chronic and severe asthma who lived in an area referred to as “Asthma Alley” instead lived in an environment with clean air? What if the woman who came to the outpatient AIDS clinic didn’t have to choose between paying her rent and paying for her HIV medication?

I can only imagine that it would have been really, really different.