Written by Karen Lin, CEO, Emotivo Health
What could you do with $480 billion? That’s what the US spends annually on avoidable and unnecessary expenses related to mental health inequities. This includes the healthcare cost of associated chronic conditions, turnover or loss in productivity for employers, and more. Many inequities stem from health-related social needs (HRSN), such as income, stable housing, access to healthy food, transportation, education, and cultural or language barriers. As multiple metrics have shown a growing mental health crisis, how can health insurers and employers spend differently to reverse these trends?
For instance, a member’s transportation is unreliable, so they spend more time commuting, and get less sleep. They also skip preventive care because the doctor is difficult to get to. This results in more sick days due to poor health. Anxiety about losing their job from increased tardiness and missed days creates discordant behavior with family and coworkers. Their employer loses revenue from lower staff productivity. And turnover increases spend on recruiting and training.
What if the transportation problem were addressed before things can snowball? Could preventive care be administered at work? How about offering more reliable transportation options to employees? Or give travel stipends. You might say, sure, if I had more money, I would have more options and be happier. But there are limited budgets and so many people with varying needs to consider.
Charting The Course
A large innovative health insurer has found a way to identify outsized savings, along with improved health outcomes and member engagement. They created a new health scoring method that goes beyond the inputs of traditional risk scoring. It incorporates data on social needs that contributes to half the score, while acute or chronic conditions and traditional measures make up the rest. Despite behavioral health contributing to less than 20% of the score, lower scores correlate with mental distress, while high scores align with more self-reported mentally Healthy Days.
John Gorman, the founder of Nightingale Partners, the first Opportunity Zone fund to invest in social determinants of health interventions, uses a similar concept to determine where and what to invest in. They use 5,000 publicly available data sources, going beyond what most organizations already review – income, race, and ethnicity. More specialized data includes over the last two years who checked into a homeless shelter or a food bank, had a car repossessed, or had a home foreclosed. Mapping that data visually into a health plan’s service area makes hotspots easy to identify where types of services will meet the most need. “Your zip code is a far greater predictor of your healthcare costs than your genetic code,” says Gorman.
Strategic Investments
The innovative health insurer found that rural Appalachia had some of the lowest healthiness scores. They invested in creating healthier mental outlook for children through school-based programs run by a community-based organization. This initiative didn’t just reduce substance use and mental health disorders in students. It also benefited the mental health of their families and school staff, given how mental disorders can affect the caregivers. The health of the entire community improved.
In another rural health example, a different insurer learned that uncontrolled diabetes cost them $248,000 per member per year. No solutions made significant impact until Gorman suggested a medically appropriate meal delivery service for those members. Within 14 months, the pilot brought average costs down to 48,000 per member per year, a 35x return on investment. “Dealing with basic[s] like poverty, tend to be cheap interventions that have massive impact,” says Gorman.
How To Get Started
Proactively offering more value to members can go a long way to build trust. The innovative health insurer used their healthiness score to find an opportunity to improve population health in urban areas by focusing on maternal health outcomes. People whose pregnancies end in stillbirths, have much higher risk for postpartum depression. Partnership with a non-profit increased member engagement with a stillbirth prevention app. This created trust in members to respond to in-app surveys about their social needs.
Gorman suggests health plans at the very least “to ask [members] what they need that they’re not getting from you.” If health plans don’t identify these correctly, or remove popular benefits, members “are going to walk right across the street and go to your competitor that’s still offering.” So payers need to invest in collecting the most social needs data, with accuracy.
Consider where existing data and touchpoints occur with patients, such as recorded call center conversations or telehealth visits. In these calls, members already mention what they need, but is the health plan processing conversation data into something actionable? And if member concerns are successfully handled, is your staff taking the opportunity to screen for social needs?
We’re still in the nascent stages of systematic identification and precise action on addressing inequities in mental health. But there’s already clear correlation between geographic areas and health outcomes. Whoever wields their data best, to uncover social needs will take the lead in cost savings and clinical outcomes. AI is ready to jump in to assist. By investing in tools to gather data and identify cost-saving opportunities, employers and insurers can both protect their budgets and improve the lives of those they serve. The future is looking bright with the innovations and investments of payers and investors like Nightingale Partners.
Learn more about how Emotivo can process conversation data.
Karen Lin has a record of launching b2b and consumer products in various startups and public companies. She has built systems for health systems to measure patient safety culture, identify risk triggers, and benchmark quality across their organizations. As a woman in software roles for many years, she has gotten used to being the only woman in the room and advocating for those not present. Her current focus is to make patient conversation data actionable for payers and providers through AI.