Personal Determinants: Opportunity to Enhance Health Outcomes, Lower Cost

The following article was originally posted on on the?Mercer US Health News blog .?You can find this article along with more health news content?here .

By Kristin Parker, PhD , Total Health Management Specialty Practice Leader, Mercer and Agnes Quiggle , Health & Benefits Consultant

It's time to change the way we think about health as we age. The next big opportunity to maintain or even improve our health goes beyond today’s traditional approach, which is focused on mitigating risk, such as an individual’s own medical risk and the risks arising from their social environment. While risk factors are important, the full picture of a person’s health also includes their strengths and capabilities – the personal determinants of health.

What are the personal determinants of health?

Personal determinants of health (PDOH ) are internal strengths that enable an individual to tackle life’s challenges. Throughout our lives we must constantly adapt to change and deal with challenges. Resiliency is how we adjust to or recover from those changes and challenges.?Current research ?suggests that many factors contribute to resiliency, including three that are particularly meaningful and malleable:

1) Purpose: your goals, direction and life meaning

2) Possibilities: your level of optimism about the future

3) People: your strong social connections

Research ?also shows that if resiliency is taught in youth, it confers lifelong advantages for an individual’s health, wealth, and career. But it is never too late for someone to learn new life skills – and employers that facilitate such learning could benefit as much as their employees.

Why are the personal determinants of health important?

AARP Services Inc. (ASI) and UnitedHealthcare (UHC) jointly formed a Healthcare Transformation Team (HCT) that is exploring how these three PDOH factors – purpose, possibility, and people – can improve the health and well-being of the members of their Medicare Supplement plan. A recent HCT study, in which members were assessed and given scores for PDOH, found that those with higher scores had lower medical costs. For example, medical costs were 12% lower among members with the strongest sense of purpose, and 24% lower among members with the highest level of resiliency1.

What makes this study so intriguing is the fact that PDOH scores can improve. The HCT team piloted a number of programs aimed at building greater resilience, purpose, and optimism and improve their social connections. Across all pilot programs, 47% of participants improved their resilience, 49% improved their sense of purpose, 44% improved their optimism, and 48% improved their social connections2. In addition, individuals acquired new skills and habits including setting goals, practicing self-compassion and prioritizing self-care. A focus on PDOH provides an innovative path forward to enhance individuals’ physical health and overall quality of life – and, in doing so, curb medical spending as well.

How PDOH differs from social determinants of health

Social determinants of health (SDOH ) are nonmedical factors influencing individuals’ health status, including their education, income and health beliefs, along with the external social and physical context of their lives — families, schools, workplaces, neighborhoods and the larger political economic organization of society.?While addressing SDOH is critically important, infrastructual change may require considerable time and resources. In addition, not all of us respond the same way to social and physical environments and challenges. In contrast,?PDOH are the internal, positive resources and skill sets that help individuals change the way they view and respond to their environment.

Why should employers care?

?A?study ?by Musich et al that investigated the effects of purpose-in-life, resilience, optimism, internal locus of control and social connections found that with each additional psychosocial protective factor (i.e., personal determinant of health) in place there was a reduction in cost of $1,356 per factor, per year.?In addition, depression was decreased by 66% for those having one protective factor versus zero, and perceived stress decreased about 17% per protective factor added. Therefore, the time is now to intervene and support employees’ often overlooked personal determinants of health.

Employers can put these concepts to work by providing tools and resources to their employees to improve their skill-building potential in the areas of purpose, optimism and social connections --which is needed more than ever, with our society still reeling from the COVID-19 pandemic. It’s time to tap into this incredible opportunity to enhance health outcomes, decrease medical cost, and have happier employees.

1?Results based on 2018 Life Survey Data, N = 3,504 participants. Individual relationship between each construct and medical cost adjusted for social demographics and health status. *Adjusted Average Cost accounted for Age, Gender, Region, Rural/UrbanDesignation, Minority Designation, Median Household Income, and CCI Score (unless otherwise specified).

2?Results based on phase I Aging Strong AARP Medicare Supplement pilot participants Aging Strong summary analysis.

AARP Services Inc. (ASI, a taxable subsidiary of AARP) and UnitedHealthcare (UHC) formed a Healthcare Transformation Team (HCT) in 2008, which works to help seniors live vibrant and fulfilling lives by focusing on the personal determinants of health. ASI and UHC joined forces to better understand the characteristics, needs and general health of older adults within Medicare Supplement coverage. Their work together explores how the perceptions, costs and health outcomes of aging impact society, and serve as a learning laboratory to test and refine a variety of services and programs with the foundational objectives of improving healthcare outcomes, member experience and affordability of care for Medicare beneficiaries.