Topic: Integrating SDoH (social determinants of health) interventions to achieve equity

in health using health-tech solutions

Background (on UnitedHealth Group & Optum)
• Ranked Fortune #5 and with over $257 billion of annual revenue, UnitedHealth Group (UHG) is the largest health care and
wellness solutions company in the world.
• Optum, the fast-growing part of UnitedHealth Group, is a leading information and technology-enabled health services
business.
• Optum serves virtually every dimension of the health system, with a diverse set of clients such as those who diagnose and
treat patients to those who pay for care, manage the delivery of health services, and those who supply treatment and
disease management solutions in the form of medications and devices.
• Optum is dedicated to modernizing the health care system and improving the lives of people and communities, by
providing technology and tools that enable unprecedented collaboration and efficiency across various levels of healthcare
delivery.

At Optum, our mission is to help people live healthier lives and to help make the health system work better for everyone. We
are tackling the biggest challenges in health care by designing multifaceted solutions, creating actionable insights and
partnering with stakeholders across the entire ecosystem. Together, we are transforming health care for a better future for
everyone we serve.

Context
Social determinants of health (SDoH), as defined by the WHO, are conditions in which people are born, grow,
live, work, and age that can shape their health and influence their functioning and quality-of-life outcomes
(Figure 1).1

In the last decade, several real-world studies have evaluated the impact of SDoH on disease risk,
complications, associated mortality and the significant disparities in healthcare outcomes. Collectively, SDoH
(such as housing status, food access and availability, transportation barriers, income, employment, education,
built environment and access to healthcare) are considered as nonclinical health parameters that can
collectively impact 80% of all health outcomes.2
The COVID-19 pandemic has further amplified the importance of SDoH in managing healthcare outcomes. The
pandemic-induced tide of unemployment, more widespread insecurity with respect to food and housing and
long periods of social isolation have further exacerbated health disparities based on race, ethnicity, language,
income, sexual orientation and gender identity. The fallout was understood acutely when nearly 8 million adults
in the US lost their jobs between March and June 20203 and more than 20% of adults had to forgo taking their
medications for chronic diseases amid pandemic-sparked financial stress. During the pandemic’s duration,
significant spikes in morbidity and mortality rates for various diseases were reported in Hispanics, Asian
Americans, Native Americans, and Black Americans. Food access and availability status in several vulnerable
population groups underwent a dramatic shift with a significant increase in number of individuals seeking
support from food budget programs like the Supplemental Nutrition Assistance Program.

In recognition of the immense effects of SDoH and the industrywide shift to preventative care, 4 healthcare
organizations in the US have been steadily investing in SDoH solutions. These SDoH solutions include data-
analytics driven platform to connect people to community-based services so they can stay well, meet basic
needs, manage illness and care for others. These solutions are aimed at supporting a full spectrum of needs
including things like in-home personal or nursing care, food/nutrition, housing, mental health, or support with
cancer, diabetes management or caregiving. In tandem, several tech companies have been offering services and
products that range from wearable devices to providing rides to local healthcare facilities. At the level of health
systems, in 2019, over 78 programs that collectively involved at least $2.5 billion of health system funds was
specifically committed to SDoH interventions to improve community conditions that affect health (Figure 2).
These SDoH programs have been initiated to reduce the total cost of care by redesigning the ways in which
health systems provide core services to better meet the needs of vulnerable populations.

The evaluation of these SDoH programs have shown that programs focused on multiple social determinants
have resulted in positive impacts on healthcare outcomes. Implementation of SDoH programs till date have
also made the healthcare entities aware of the constraints in the scalability of SDoH programs and are
seeking technological drivers and innovative solutions to bridge the widening health gaps due to race and
ethnicity, housing instability, food insecurity, employment, poverty, access to foods that support healthy
eating patterns, environmental conditions and so on.

Innovation is at the core of Optum’s mission to help people live healthier lives and make the health system
work better for everyone. Optum invests $3.6 billion annually in research and development in order to
employ the latest developments in technology and push the boundaries in achieving desired healthcare
outcomes for all stakeholders.
Health-tech companies like Optum have a lot to give by leveraging its platforms, devices, and computing
power. It is constantly seeking innovative health-tech solutions to connect patients with resources and to
translate SDoH data into actionable insight and power SDoH initiatives by bringing together disparate
strands of emerging technology and iterate, adapt or invent approaches that are tailored to meet the
specific needs of patients, health care practitioners, providers, payers and all other stakeholders across
the health care spectrum.

Problem Statement
Health payers, providers, and policy leaders agree on the importance of implementing SDoH-driven
solutions to achieve equity in health. However, several technological barriers prevent health plans and their
partners from identifying beneficiary social needs and taking crucial steps towards addressing those needs.
Factors that have impeded effective implementation and application of SDoH frameworks within the US
healthcare system include (but are not limited to) the following:

• Organizations and systems that typically address SDoH (such as those for managing food insecurity,
housing instability, and community support) often exist outside traditional health care systems. This
limits the ability of health plans or providers to address or coordinate SDoH-driven services directly
• Provider inhibitions and gaps in conventional clinical workflow systems often prevent appropriate
recording, collection and storage of SDoH data during healthcare encounters
• Despite availability of SDoH databases and analytics generated by third-party vendors, several gaps
exist in integrating SDoH data with concomitant claims data and clinical findings in large-scale
health delivery systems. There is a need for innovatively braiding the data streams coming in from
various clinical and non-clinical sources before generating actionable insights with ascertained
veracity. This often limits the inferential value and quality of SDoH-based insights to be applied in
relevant population groups.
• Effective capture of SDoH data and analytics in hospitals will require increased alignment with
value-based care frameworks and applications for bridging gaps arising from disparate systems
employed by payers and hospitals.
Restructuring of care pathways and training of physicians/healthcare personnel in addressing SDoH will be
required to accelerate adoption of systems that support the transition to value-based care using SDoH.

Key point/question(s) to be addressed

While presenting your proposed solution, your team needs to consider the following key points/questions:

• Design an SDoH-based healthcare solution/business model based on (but not limited to)
technological solutions and learnings from other industries etc. to serve the problems/underserved
needs related to SDoH mentioned above
• Evaluate the healthcare market drivers and restraints and the strategic role that Optum can play
(with due considerations for its current standing, capabilities and synergies) to address the
healthcare needs of vulnerable populations with a disproportionate risk of health outcomes
• Outline the adoption, communication and positioning strategy for your solution
• Discuss the timelines and financial implications with respect to your team’s solution, and the
potential executional roadblocks and risk mitigation considerations that need to be managed.
• Give your point-of-view on the care pathways that will address the factors impeding the effective
application of SDoH interventions in achieving health equity in the US healthcare system
You will be evaluated on following criteria:
1. How realistic the proposed solutions are, considering the 3-year time horizon, while exploring
future possibilities of healthcare delivery
2. Holistic approach proposed to tackle the situation at the level of users (patients), healthcare
providers, payers and internal stakeholders
3. Uniqueness and innovativeness of your solutions
4. Your understanding and grasp of the US healthcare system and related issues
References
1. World Health Organization. Social determinants of health: what are social determinants of
health? [Internet]. Geneva: WHO; [cited 2021 Sep 30]. Available from:
https://www.who.int/social_determinants/en/
2. Manatt P, Phillips LL. Medicaid’s role in addressing social determinants of health. Briefing
series: key Medicaid issues for new state policymakers. Robert Wood Johnson Foundation.
3. Fronstin, P. and Woodbury, S.A., 2020. How Many Americans Have Lost Jobs with Employer
Health Coverage During the Pandemic?.
4. Horwitz LI, Chang C, Arcilla HN, Knickman JR. Quantifying Health Systems’ Investment In
Social Determinants Of Health, By Sector, 2017–19: Study analyzes the extent to which US
health systems are directly investing in community programs to address social determinants
of health. Health Affairs. 2020 Feb 1;39(2):192-8.