Dr Ed Clarke Discusses Health Systems Investing in Social Determinants of Health

Ed Clarke, MD, of Banner Health, weighed in on whether he agreed or disagreed with the commentary titled "Health Systems and Social Services—A Bridge Too Far?" which stated that health systems should not invest in social determinants of health.

This topic was further explored during the panel discussion at The American Journal of Managed Care^®’s Institute for Value-Based Medicine^® (IVBM) in Phoenix, Arizona, on December 12, 2023. Clarke, who is the vice president and chief medical officer of the Banner Health plans and networks division, cochaired the event and helped to moderate the panel.

Transcript

You helped to moderate a panel discussion on ideas from "Health Systems and Social Services: A Bridge Too Far?" in which the authors disagreed that health systems should invest in social determinants of health. Do you agree or disagree with the points made in this commentary? Why or why not?

I agree with parts of it. Especially where I sit and where my teams are at Banner Health, where we have made these strategic decisions as what was historically a delivery organization and a group of hospitals, we have made the decision to take risk on outcomes of populations by owning insurance plans and taking more risk. From our perspective, it's just become the work; we have to do that.

They do make some excellent points in the paper, because not everybody has the ability to own or participate in a joint ownership of health plans. Similar to the points made around PCPs [primary care providers] having so much to do, it's no different in inpatient settings. I think if you talk to almost anyone, "Do you feel you have more work to do in a given day now than you did 10 years ago or less?", they would all say, "I have more work to do with probably a smaller amount of resources to get it done."

I think we just have to be thoughtful to find that balance; I certainly don't have all the answers on that. It's definitely not a one-size-fits-all thing. What I hope, and what a lot of our panelists hit on, was we really need intervention from our government. So, our politicians have to be involved in this, and that was a point that was raised by some in our audience. In fact, several said they appreciated the panelists we had and the speakers, but a request was made for local and state and national politicians at forums like this to talk about what they're doing to help us.

Could you please summarize points made during the discussion that stood out most to you?

Some of the things that stuck with me were that getting these data is still challenging. Screening is one thing, but how do we receive the data ahead of time from our health plan partners or other entities? So, outside of us having to screen our individual populations and take action, can they share these data with us up front and make more programs available so we can take action? That was one thing that stuck out.

Also, again, screening is one thing, and then the documentation of the various Z codes and other things. Again, our new workflows and what is perceived a lot of times as more work on an already stressed group. So, is there a way that we can streamline that? There's still some hesitancy in using Z codes and other things to document these things. Some feared that the data could be used in ways that we don't yet understand, and patients and others may not exactly understand how these data are being shared because these are collected in EMRs [electronic medical records] and in other spots too.

So, still a lot of questions around what we all can do with the data, and how will this data risk adjust our populations, especially for those of us who take risk or have a lot of value-based contracts in our payer mix? So, understanding how we get credit for having panels with more social determinants of health vs less. Is there any relief there, or how will acknowledgement of that work? I still think we have some unanswereds there.

Lastly, some points made were, until we have more capitative models or just full risk pass to the provider entities, we're still likely to be in this kind of middle space where it's really hard to go all in on these things, or we just don't do anything. Especially as we all educate ourselves better on the impact this has and clearly understand that, "Okay, we need to address this, and here's how we're going to do it," you need those dollars potentially up front so you can make those investments well ahead of time so that you will create those good outcomes. So, trying to do it all now on the hope that maybe there will be a windfall on the back end in an already kind of stressed and overburdened primary care ecosystem is just a tough task.