the social service business case for healthcare · sxsw march 8, 2019. with you today eveline van...
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The Social Service Business Case for
HealthcareSXSW March 8, 2019
With you today
Eveline van Beek
Managing Director
Healthcare & Government Solutions
KPMG LLP
Tanya Shah
Assistant Vice President, Delivery System Reform
The Commonwealth Fund
Maya Altman
Chief Executive Officer
Health Plan of San Matteo
Carolyn Ingram
Senior Vice President, Policy and Government Affairs
Molina Healthcare
20% 20% 60%GENETICS HEALTH CARE SOCIAL, ENVIRONMENTAL, & BEHAVIORAL
.
Illustration adapted from: Taylor, L. A., Coyle, C. E., Ndumele, C., Rogan, E., Canavan, M., Curry, L., & Bradley, E. H. Leveraging the social determinants of health: what works?. Report on Blue Cross Blue Shield of Massachusetts Foundation, (June 2015)
What Determines Health Outcomes
Source: OECD Social Expenditures database (SOCX), OECD Health data 2018.
Data: Expenditures reflect the latest (2013-2016) available data for combined public and private spending. To avoid double counting, social care expenditures reflect total social spending in SOCX excluding health spending included in SOCX, while health care expenditures reflect total health spending in OECD Health Data excluding long-term care (social), health promotion with multi-sectoral approach, and gross fixed capital formation.
Health and Social Care Spending as a Percent of GDP
11 9 11 10 11 912 10
1811 12
12 14 1320 20 22
19 21
1724 25
0
5
10
15
20
25
30
35
40
NOR AUS CAN UK GER NZ SWITZ NETH US SWE FRA
Health care Social care
Source (for Obesity Rate and Adults with Multiple Chronic Conditions graphs): OECD Health Data 2018.Source (for Adults with Multiple chronic conditions graphs): 2016 Commonwealth Fund International Health Policy SurveySource (for Mortality Amenable to Health Care graphs): Marina Karanikolos, European Observatory on Health Systems and Policies (2019).
Worst Outcomes Despite Higher Healthcare Spending
Obesity Rate, 2016Percent (%)
Life Expectancy, 2016 or Nearest YearYears
Percent (%)
Adults with Multiple chronic conditions, 2016Percent (%)
Mortality Amenable to Health Care, 2016
Social determinants of health: a quick overview
Source: Adapted from H.J. Heiman and S. Artiga. “Beyond Healthcare: The Role of Social Determinants in Promoting Health and Health Equity”. Kaiser Family Foundation: Washington DC, 2015.
Economic StabilityNeighborhood and
Physical EnvironmentEducation
FoodCommunity and Social
ContextHealthcare System
Health Outcomes
Case Management in the Field: Cliff’s Story
Establishing Supports Prior to Release
ISSUE: 60 year old male released from prison after 28 years with no family or support system to return to and a total personal savings of $75.
ENGAGEMENT: Case manager worked with jail pre-release program to engage individual and educate him about his benefits, and conduct a comprehensive health assessment which revealed indications for Hep C, Asthma, and Depression.
COORDINATION: Case manager arranged for assisted living with a housing partner, connected the individual with a multi-disciplinary care team, and provided transportation to attend treatment, all prior to release. Molina continues to support his progress towards health and independence.
Jail Diversion: The Business Case
ISSUE: During a period of incarceration longer than 30 days, Medicaid coverage is suspended and any work carried out by a plan prior to the release date is not covered.
COORDINATION: Care coordinators were deployed to coordinate medical and behavioral healthcare services (including medications), secure housing and employment, and connect inmates to familial and social supports upon release.
REDUCED RECITIVISM: Engaged participants had lower jail-recidivism rates (16%) as compared to non-participants (40%). For the 125 participants, an average of $7,854 per member per month savings were generated.
From Immobility to a Full Life
“The program gave me a place to call home where I have made many friends”
Conrado Solano
INSTABILITY: Large medical bills, Unpaid mortgage and potential foreclosure, Lived in long term care for 3+ years
INTERVENTION: Enrolled in pilot program, Moved to affordable housing, Provided in-home medical and supportive care, Coordinated with other services
INDEPENDENCE: Graduated from pilot program, Received ongoing case management for complex needs, Alleviated isolation and loneliness
Community Care: The Business Case
Needs: Patients living in nursing homes long term
with complex medical and non-medical needs (care management, non-
medical services, housing, etc.)
Response: Identified 244 members to engage with in the Community Care Settings Pilot (CCSP) to
provide care coordination and three housing
options: assisted living, in-home support,
affordable housing
ROI Results: Achieved 41% savings when
comparing 6 months pre/post plan costs, an
average per member per month spending of
$10,049 compared to $5,970; majority of
savings coming from reduction in long-term
care and healthcare costs
Impact on Members: 95% would recommend the program to family
and friends and 91% felt program maintained or
improved their quality of life
Spotlights from the Field
$4,079in savings
(per patient per month)
Avoidable Utilization
$5,177–7,857in savings
(per patient per month)
Blood-Sugar Levels
$3,423in potential savings
(per patient per month)
Patient Adherence
Keep the conversation going
Eveline van Beek
KPMG LLP
Tanya Shah
The Commonwealth Fund
Maya Altman
Health Plan of San Matteo
Carolyn Ingram
Molina Healthcare
@KPMG_US
@KPMGHealthcare
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