Typical attempts at defining, quantifying, and measuring social determinants of health (SDoH) are limited to geographic or population averages, which often mask individuals’ discrete and unique experiences. They can, therefore, lead organizations to implement costly and inefficient programs instead of addressing individuals’ actual barriers that represent the greatest potential for improving health outcomes and return on investment.
Recognizing this, the Colorado Hospital Association (CHA) sought to gain a better understanding of the unique fingerprint of risk within its members’ patient populations—knowledge that would lead to more effective strategies for its members to address emergency department (ED) super-utilization and readmission rates with interventions that would produce the greatest return on investment.
The group partnered with Carrot Health to perform a statewide analysis on the relationship between ED utilization and readmissions and SDoH. Coupling claims data from CHA’s On Demand Hospital Information Network (ODHIN) and consumer behavior data from the Carrot MarketView platform enabled production of an industry-first analysis of healthcare utilization across Colorado.
SDoH and Readmission
The analysis provided deeper insights into the patterns and relationships observed through patient data, social risks, and ED utilization and readmissions. The latter – readmission – is a core utilization metric that has been identified by Colorado’s Medicaid payer as a key metric impacting hospital reimbursement under Colorado’s value-based Hospital Transformation Program (HTP). As a result, improvements in readmission and optimization of quality programs around it are paramount to CHA’s member hospitals.
Readmission is also an area where SDoH can have a significant impact, particularly within the Medicaid population where social determinants are often exacerbated. For this reason, the CHA determined that identification tools would play an important role in helping to quantify risk and identify opportunities for strategic program design, community outreach, and interventions by allowing for the visualization and highlighting of the relationship between readmissions and SDoH.
This would, in turn, allow CHA to determine the appropriate guidance for member hospitals seeking improvement in their quality efforts. To that end, CHA and Carrot Health constructed an interactive dashboard to help hospitals understand their specific patient population by identifying those who had been readmitted within 30 days and which SDoH were contributing to overall risk for readmitted patients.
The dashboard allows CHA to identify areas of increased social risk for by comparing patients who were readmitted against those who were not. It also allows member hospitals and health systems to examine patient populations by ZIP Code, payer, race/ethnicity and SDoH risk groups and draw insights within each population.
Minority communities are incredibly diverse, particularly when looking at population mix and rural vs. urban areas. From different household makeups and risk factors to varying engagement preferences, that diversity also impacts health outcomes—a reality laid bare by COVID-19.
An analysis by Carrot Health found that rural communities bear the highest burden of COVID-19, while Black and Hispanic populations are the most adversely impacted by the virus.
This infographic takes a closer look at diverse communities with large Black and Hispanic populations, information that can be leveraged to improve health outcomes, member engagement, costs and public health.
The healthcare business of LexisNexis Risk Solutions announced a collaboration with Carrot Health, a provider of solutions powered by consumer and healthcare data. The collaboration enables Carrot Health to incorporate social determinants of health (SDoH) data from LexisNexis Risk Solutions into its SDoH data and analytics software platform to guide payer and provider decisions around member engagement and health management.
Through this collaboration, Carrot Health will integrate clinically-validated SDoH attributes from LexisNexis Risk Solutions into its existing Social Risk Grouper (SRG) taxonomy and other predictive models that leverage vast consumer and healthcare data. These insights will inform consumer-centric strategies to improve health outcomes, reduce costs and prevent readmissions.
“Consumer attributes are among the most powerful factors influencing health outcomes, creating barriers and inequities that prevent populations from leading their healthiest lives. Carrot Health’s SRG harnesses this information to measure and monitor social determinants of health at the individual level, providing comprehensive insights our customers need to design strategies for identifying and closing gaps in care while providing a more personalized member experience,” said Kurt Waltenbaugh, CEO, Carrot Health. “We chose LexisNexis Risk Solutions after extensive evaluation and testing because their consumer data proved to be the most accurate and comprehensive in the market. We are excited about this addition to our platform as we continue to help payers improve member health.”
Carrot Health’s platform harnesses clinical, social, economic, behavioral, and environmental data to deliver insights for growth, health, and quality, providing health plans with a 360-degree view of their members. Carrot Health is delivering the healthcare industry’s first solution for consumer insights at scale, along with individual-level SDOH scoring and monitoring for every adult in the United States.
This scoring model helps predict the likelihood of an individual having an adverse health outcome due to their SDoH profile. The data from LexisNexis Risk solutions will augment Carrot Health predictive models, that already includes consumer data, ICD-10 Z-codes, publicly available health indicators, claims, survey responses, and other proprietary data ? providing unmatched accuracy to a scoring model.
By Rachele Elasky, product manager, and Sarah Chien, analytics solutions manager, Carrot Health.
The Centers for Medicare and Medicaid Services (CMS) in recent months predicted both lower premiums and richer benefits for Medicare Advantage (MA) plans in 2021. Specifically, CMS anticipated a decrease in average premiums of more than 34% from 2017 levels while plan choice, benefits, and enrollment increased—making the average monthly premium the lowest in 14 years.
But while CMS accurately depicted the indisputable trend of moving toward lower costs and higher value in MA offerings, it did not tell the whole story. To do that, we consolidated and reported on all Medicare Advantage and Prescription Drug Plan (PDP) benefit data nationwide released by CMS. This provides a much clearer picture on how these trends impact individual members vs. across member populations.
Following are the highlights of that analysis.
More Plans Offered Than Ever Before
There will be a 13% increase over 2020 in the number of MA plans available nationwide for individual enrollment in 2021. At 3,545, this is the most plans ever offered and includes 665 new plans—a nearly 4% increase from the 642 new plans offered in 2020.
While MA enrollment is rapidly increasing, the competition is growing even faster. In 2021, there will be 21.5 MA plans in the country for every 100,000 beneficiaries. That compares to 16.8 plans per 100,000 in 2018, which is an increase of more than 53% in just four years.
This growth is not uniform across the country, however. Densely populated markets in the Northeast such as metropolitan geographies typically have the most plans to choose from although enrollment growth rates have been higher in more rural areas of the country in recent years.
New Plans, More Value
New MA plans being introduced into the market for 2021 generally offer more value than existing plans through lower premiums and richer benefits. Among new plans, premiums are one-fifth of those for existing plans ($9 vs. $42), anticipated out-of-pocket costs are lower, and nearly every supplement benefit is offered at a higher rate.
Carrot Health, a provider of healthcare solutions powered by social determinants of health (SDoH), announced it has been named a finalist in the Accenture HealthTech Innovation Challenge – Health North America. Carrot Health was one of 13 companies to compete in the Boston regional round of the competition, which supports innovative technologies and drives creative solutions to improve the way people access and manage healthcare.
“We are honored to have advanced to the finals in this important program. Innovation is the engine that drives crucial improvements in healthcare, such as the ability to leverage key SDoH data to close critical care gaps by addressing the non-clinical needs that impact as much as 80% of health outcomes,” said Kurt Waltenbaugh, CEO of Carrot Health. “The caliber of technology solutions presented by our fellow competitors in the Boston round of the HealthTech Innovation Challenge was outstanding, and we are honored to have been among them.”
Carrot Health, which moves on to the finals taking place in Houston in February 2020, was selected for its Carrot MarketView platform, which generates insights for growth, quality and health using social, economic, behavioral and environmental data. MarketView helps healthcare organizations by leveraging consumer and clinical data to deliver a 360-degree view of the patient.
Validated in the market, Carrot Health’s predictive models and insights have proven effective at:
Driving growth by identifying consumer needs
Improving health outcomes by influencing key performance metrics, such as emergency department utilization, admission/readmission, cost of care and mortality
Enhancing quality by closing care gaps and improving customer satisfaction
“MarketView encourages health organizations to address appropriate needs along the full healthcare hierarchy, identifying and eliminating bottlenecks before they can adversely impact quality, care outcomes and costs,” said Waltenbaugh.
Since its inception, the Accenture HealthTech Innovation Challenge has brought healthcare organizations and startups together to tackle the world’s biggest health issues. Over the life of the program, Accenture has received more than 2,200 applications, invited more than 90 startups to compete, benefitted from the time and guidance of nearly 1,000 executive judges, and awarded 10 trophies to the most innovative healthcare startups. The Health North America challenge brought together innovative startups across North America to compete in a challenge focused on solutions in the areas of operational efficiency, increased access and consumer experience.