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Elevate Senior Care by Addressing Social Determinants of Health

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The baby boomers have grown up and are about to disrupt Medicare. Aged 55-75 years old and projected to make up 20% of the U.S. population by 2030, boomers have been aptly coined the “silver tsunami.” This tsunami will no doubt transform the government-run program that serves the healthcare needs of over 60 million U.S. residents.

To meet the challenge of delivering optimal healthcare to this diverse group, providers and clinicians are looking more closely at ways to address social determinants of health (SDoH) to improve health outcomes, reduce health disparities, and lower overall costs for Medicare and Medicare Advantage programs.

No doubt about it, SDoH influences everyone’s health, especially the elderly and the most vulnerable among us. Let’s gain a deeper understanding of how to streamline processes that foster coordinated care across health teams and heighten patient engagement to more effectively improve the health of your Medicare Advantage members.

What are the Five Social Determinants of Health (SDoH)?

SDoH includes the range of economic, environmental, and social factors that impact an individual’s health. According to Health People 2030, social determinants of health fall into five categories:

  1. Economic Stability
  2. Education
  3. Health and Health Care
  4. Neighborhood and Built Environment
  5. Social and Community Context


Each of these domains is interconnected. It’s the interplay between the individual and each of these categories that plays a considerable role in our health and well-being throughout our lives.

As we dive into SDoH, what becomes apparent is that healthcare inequities for vulnerable populations, such as food insecurity and education opportunities or lack thereof, are baked into where one is born, lives, plays, works, and ages.

When discussing factors that are of significance to an individual’s health across the lifespan, it’s important to identify the social determinants of health inequalities to provide the care that the individual patient needs most.

Why Addressing SDoH is a Growing Concern

By recognizing the myriad of ways an individual’s healthcare outcomes are impacted by social, economic, and environmental risk factors, healthcare organizations are better positioned to deliver high-quality care that maximizes available resources.

In fact, studies show that when an individual’s unique SDoH factors are recognized and addressed, providers are better able to minimize or altogether eliminate barriers to care, resulting in a 30% reduction of overall healthcare costs per patient.

As healthcare organizations incorporate SDoH into how they deliver care, clinicians will have greater flexibility to view their patients’ healthcare in a holistic way. As the patient receives more personalized care that addresses their specific social, economic, and environmental circumstances, costs may be reduced and health outcomes and overall patient well-being improved.

How to Optimize Patient Engagement by Addressing SDoH

The pandemic has revealed the growing mistrust citizens have in our nation’s institutions. Unfortunately, this mistrust extends to doctors and health providers. The foundation of patient engagement must be based on trust so that both patient and provider enjoy a genuine partnership in addressing SDoH and inequities in care.

Here are a few ways providers may optimize patient engagement by addressing SDoH.

Early and Consistent Communication

Early on in the patient-provider partnership, the healthcare provider must foster an open channel for communication. This may include live phone calls, emails, or text messages.

It’s advised that the method offered is chosen by the patient, based on their convenience and comfort level with the communication channel. When patients feel they are listened to and heard, they may be more open to receiving provider help, thereby boosting engagement and collaboration.

Establish Rapport with Health Assessment Outreach

The human touch goes a long way in establishing rapport and trust and uncovering the unique barriers to health an individual may face. When health risk assessments are gathered, the point person that may receive the most relevant and honest patient responses are often trained engagement specialists, if available, and members of the healthcare team, such as nurses.

Care Coordination Across Healthcare Teams

When healthcare teams communicate patient information, such as office visits and medications, not only do patients receive safer and more effective care, they feel more connected and engaged with their healthcare team.

Personalize Solutions with Technology

To deliver a personalized healthcare action plan that addresses SDoH, providers must have both patient trust as well as data. Solving the SDoH puzzle for each patient requires drawing from disparate siloed data.

Through data integration of electronic health records, patient portals, patient 360, and other independent sources via a healthcare data platform, providers may then segment risks and respond in kind with the most effective means of communication and management for the patient.

Skypoint Cloud’s healthcare data platform provides a complete patient 360 view with social determinants of health (SDoH).

You’re able to incorporate SDoH into personalized care plans based on patient 360 data and insights collected from your entire population into individual patient profiles. Skypoint also allows you to direct members to the appropriate resources for their unique needs and engage through the optimal channel and time period to ensure a coordinated care experience.

Learn about Skypoint’s Medicare Advantage solutions and how our healthcare data platform helps you address SDoH and serve patients better.

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