Making a Lasting Difference in Members’ Lives Through Innovation

Within the United States, health inequities and disparities are long-standing issues, leading to poor health outcomes, especially for under-resourced Americans. While many factors can influence this, most notable are social determinants of health (SDOH) — non-medical factors that directly impact one’s overall health and well-being, such as access to stable housing and food.

SDOH impact approximately 30-55% of Americans’ health outcomes, and can often be grouped into five general categories: economic stability, geographic location, social/community context, education and access to health care. In the past, efforts to address SDOH were often too uniform and too rigid. As private sector and governmental organizations recognize the need to work more closely with local partners, there is an opportunity to pursue a new, innovative approach that combines data with local voices, aligning solutions to the specific needs of each community.

Medicaid Managed Care Organizations (MCOs) like Aetna Better Health are an important part of efforts to address SDOH because MCOs are integrated with local communities and have access to actionable data. We’ve implemented our Better Together Social Impact Solutions across all 16 states we serve through Medicaid programs, using social risk analytics to identify local partnerships and connect individuals with tailored, data-informed community resources.

Analyzing Social Risk Through Data Collection

To create sustainable and effective solutions, it’s important to first identify where the greatest needs are for individuals and communities. To do this, we utilize social risk analytics, a platform that provides critical risk information at a community and member level. The model includes 70–120 individual data elements to understand a member's social risk factors and helps us address resource gaps, such as housing instability, food insecurity, financial strain and transportation barriers. ?

The data gathered also helps us to understand which SDOH has the most significant impact at the community level and enables us to make informed decisions about how to develop and support sustainable resources through collaborative partnerships. To date, over two million Aetna Medicaid members have been scored using social risk analytics, helping us improve health outcomes and overall quality of life.

Implementing Data-Informed Strategies

For the data to be impactful, the development and implementation of tailored solutions should happen on two levels: community-wide and at the individual level. Once gaps in resources and needs are identified within an area, it’s important to build and solidify relationships with community organizations and local community leaders. They help us understand the on the ground realities of each community’s needs that the data cannot always show.

For example, after our social risk analytics indicated issues with food insecurity, housing instability and economic climate in Wayne County, Michigan, Aetna started collaborating with Catholic Charities of Southeast Michigan and Wayne Metropolitan Community Action to find solutions. Our partnership will help these community-based organizations address SDOH challenges head-on, providing housing support, home repairs, employment support, food assistance and care navigation services to their communities.

To bring together community organizations and local leaders, we created Community Health Councils (CHCs) to support the social safety net. This program enables Aetna partners to work collaboratively with local organizations to identify solutions needed in communities. Across 14 states, we’re facilitating 46 CHCs. With over 450 community partners, we have combined social risk data with personal knowledge and experiences to deliver strategic, data-backed solutions in under-resourced communities.

Our social risk initiative also supports members at an individual level. Our Member REACH team (Real Engagement and Community Help) is a SDOH call center that proactively addresses the social needs of individual members, their caregivers and support providers. By initiating outbound calls to members, performing social needs screenings and connecting members with the right local care organizations, our REACH team uses their lived experience to assist members who are unable to focus on their health due to SDOH barriers. Christen Smith, one of our REACH team members shared, “It's rewarding to turn a challenging situation into a positive experience for our members. When a member expresses a need for something, and I can find multiple solutions for them it not only feels good, but it allows the member to feel valued and heard.”

Measuring Success of Community-Driven Initiatives ?

We use a combination of qualitative and quantitative metrics to measure the success of our Social Impact Solutions. These metrics help us understand the impact of our initiatives, the areas that require additional support and the potential for replicating success across different communities.

To identify and address SDOH, particularly in under-resourced communities, we’re continuing to innovate. Our Social Impact Solutions team is committed to reducing social gaps for those we serve. Our members are at the core of everything we do. Leveraging community outreach and input along with data allows us to create targeted solutions. But above all else, they help us make impactful and long-lasting differences in our members’ lives — Aetna’s number one priority.