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Addressing Social Determinants of Health - a KP Perspective | DII

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2017 Southern California Dissemination, Implementation and Improvement (DII) Science Symposium

Identifying, Addressing, and Understanding Social Determinants of Health: A Kaiser Permanente Health System Perspective
Adam Sharp, MD, MS - Kaiser Permanente Southern California
Artair Rogers, MS - Kaiser Permanente Southern California

For more information on DII, go to: https://ctsi.ucla.edu/patients-community/pages/dissemination_implementation_improvement

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Addressing Social Determinants of Health - a KP Perspective | DII

  1. 1. Identifying, Addressing and Understanding Social Determinants of Health: A KP Health System Perspective Artair Rogers, MHA Adam L. Sharp MD, MS Care Improvement Research Team Department of Research and Evaluation
  2. 2. Agenda  Overview of Health Leads Pilot Implementation  Evaluation Plan  Patient Perspective  Improvement Process  Discussion
  3. 3. Implementation Strategy: Region Level Pilot at 3 Diverse Centers  West LA, Fontana, Kern Community Resource Hub  Regional call center  Central screening of predicted high utilizers  Connecting those with needs to resources  Evaluating outcomes
  4. 4. Implementation (CFIR) Characteristics of the Intervention  External vendor needed to increase capacity  Low cost  Adaptable  Centralized and Spreadable  Screening, Navigation, and Follow Up Inner/Outer Settings Individuals Involved Implementation Process  High Utilizers  Engaged Stakeholders  Call center (CRH)  Resource database  Evaluation Team  KP culture  Expected Need  Increasing Demand  Government and Health Care Sector’s Growing Interest
  5. 5. Community Resource Hub Screening Funnel 0% 20% 40% 60% 80% 100% Cold Call Screen Identify Needs Enroll 73% agree to take screen 55% have 1+ need 38% enroll 66% answer call How many members are screening positive? N= 4,101 answer call N=2,999 took screen N=1,641 screen positive N=625 enrolled 11/15/15 to 3/31/2017 N=6,220 members called
  6. 6. 6 Social Need Prevalence What are members screening positive for?  Caregiver support (52%)*  Financial (37%)  Affording healthy meals (29%)  Food didn’t last (29%) High Prevalence Medium Prevalence Lower Prevalence  Utilities (24%)  Social isolation (24%)  Transportation (22%)  Medical care costs (20%)  Health literacy/numeracy (16%)  Applying for public benefits (12%)  Housing conditions (11%)  Financial counseling (9%)  Employment (6%)  Homelessness (6%)  Housing Safety (5%)  Child-related (5%)* *12% of pilot population identified as caregivers of an individual who is physically or mentally disabled. *51% of pilot population identified as not being a caregiver of children.
  7. 7. Mixed Methods Evaluation Underway  Descriptive analysis of social needs  Patient/Provider Interviews  Patient/Provider Surveys  Quantitative analysis: utilization/costs/outcomes – Propensity scored difference-in-difference comparison – Randomized screening
  8. 8. Members’ Perspectives from Focus Groups*  Members want a one-stop shop. Call back information is desired.  Patients do feel comfortable sharing their information with community resource organizations if permission has been given.  An action plan that allows members to understand end goals and highlights next steps is desired. Follow-up schedule guided by patient.  Members ultimately value being given information about community resources but may experience barriers such as: – (1) pre-existing negative impression of the recommended organization and wanting more information from navigators – (2) discovering that they do not qualify for services – (3) administrative barriers with the community organization, and – (4) unfeasible wait times for some services (example: transportation must be scheduled two weeks in advance) *Themes derive from member phone interviews and focus groups conducted in partnership with Care Management Institute’s Evaluation Team.
  9. 9. Effort Required to Address Social Needs 9© 2017 National Quality Conference © 2017 Kaiser Foundation Health Plan, Inc. For internal use only.
  10. 10. Evolution of Performance Improvement Strategy • Number of Answered Calls (time study) • Number of Individuals Screened (scripting) Phase 1 • Motivational Interviewing • Removing Additional Barriers • Setting Long Term Goals Phase 2 (in progress) • Understanding the Positive Deviances • Creating Social Need Pathways • Seasonal Resources Phase 3 (in development) Resulted in 66 percent of all members called answering cold call; ~50% of those who answered agreed to be screened for social needs Opportunities for Improvement: • Increasing Number of Patients Enrolled in Navigation Support (28% avg.; 18% low at end of year) • Increase Number of Successful Connections
  11. 11. COMMUNITY RESOURCE HUB 2017 COHORT 1 MEMBERS WHO SCREENED POSITIVE AND PREVIOUSLY DECLINED HL SERVICES 580 246 98 COHORT 1 PATIENT LIST POSITIVE SCREENS ENROLLED 40% MEMBERS WHO SCREENED POSITIVE ENROLLED IN SERVICES Updated: 4.19.2017
  12. 12. Q+A © 2017 National Quality Conference © 2017 Kaiser Foundation Health Plan, Inc. For internal use only.12

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