Grand Rounds’ Approach to Social Determinants of Health
Categories: Employers Resources, Expert Medical Opinion, For Employers, Quality
Up to 80% of health status is attributed to social determinants of health (SDOH), and for many in the U.S., their “zip code is a more important determinant of health outcomes than genetic code.”
Social determinants of health are the conditions in which people are born, grow, live, work, and age. They include factors like socioeconomic status, education, neighborhood, and physical environment, employment, and social support networks, as well as access to healthcare. It’s important to note that for many of these conditions, the individual has limited control.
Understanding Social Determinants to Drive Optimal Health Outcomes
We recognize that Grand Rounds has a limited capacity to independently impact community socioeconomic realities, as systemic change requires long-term, ongoing shifts in policy, funding, and the design of social services. However, given our commitment to raising the standard of healthcare for everyone, everywhere, it’s within our remit, and centrally aligned with our orientation, to understand the social determinants for each member, and to deliver that member a complete care experience that addresses their individualized needs and drives optimal health outcomes.
Of the nearly 6 million Grand Rounds members today, more than half are lower-wage earners in retail, manufacturing, and consumer goods industries. These populations are more likely to live in underserved communities that are disproportionately dealing with significant socioeconomic pressures and the resulting higher prevalence of disease burden. After nearly a decade of studying and supporting underserved populations, addressing social determinants of health is foundational to how our teams deliver a complete care experience.
Ways We Deliver a Complete Care Experience
- Condition-agnostic programs built around the person, not around a diagnosis or a risk score. Our Connected Care Program starts with a trust-building conversation between the member and our clinicians (MD, DO, NP, PA, RN) about holistic determinants of health. In this conversation, our care team—trained and current in the newest techniques to build trust and elicit open, honest answers—screens each member for physical, emotional, and financial health considerations, as well as SDOH needs, including housing, food insecurity, transportation gaps, domestic safety, and financial concerns. Based on this conversation, and married with available data on the member, their historical touchpoints with the healthcare system, and geographic location, the team, and the member develop a personalized plan.
- Tailored support based on need. Multidisciplinary care teams collaborate to connect the member with both employer-provided and community-sponsored resources. For members with limited needs, our clinical care assistants coordinate services offered by the plan sponsor such as financial support, EAP, wellness programs, and community-focused initiatives. For members with more complex needs, social workers are brought in to provide direct consultation with the member, becoming an ongoing contributor to the member’s longitudinal support plan. Our social workers are empowered to identify opportunities and guide patients through the process of applying for social support services and grants or coordinating with local food pantries.
- Make it easy for teams to go above and beyond. Our teams are empowered to identify and solve root issues and are provided access to a bank of money to get the member what they need—without a burdensome approval process. For example, this could include providing a nebulizer to a patient, assuring they would then be able to administer their asthma medication at home, thereby preventing an escalation/ER or urgent care visit.
- Partner to address access issues. Through a partnership with Uber, one of the first of its kind, Grand Rounds struck a deal to enable our Care Team to order an Uber ride for a member who lacks the ability to get to and from a medical appointment. This can remediate either a transportation or cost barrier or both.
Supporting Members Holistically and Giving Them Comprehensive Access
Given our broad definition of holistic member support, we focus our attention on proactively understanding the systemic social and environmental access barriers that stand in the way of a members’ ability to effectively manage their health. This can be in any of the five dimensions of access—affordability, availability, accessibility, acceptability, and accommodation1.
- Health assistants provide holistic support. Financial constraints and inability to pay for healthcare expenses as well as goods and services that support overall good health are a major driver of suboptimal health outcomes. Our claims advocates are focused on helping members reduce inappropriate charges while stretching how far their dollar goes to cover care and ancillary services they need to improve overall health. Our teams of specialists—claims advocates and disability experts—jump in to rapidly assess the situation, research options and, to the greatest extent possible, remediate the financial or administrative issue. This can be negotiating a bill or payment plan, coordinating with a local food bank, or identifying grants and other community services for financial support. If needed, interpretation services are available to accommodate all languages.
- Contextualizing care through treatment decision support (TDS). Unlike the traditionally narrow scope of static TDS learning modules, Grand Rounds’ model of TDS gives members access to a highly credentialed staff clinician, at a convenient time for the member. TDS clinicians aren’t diagnosing or treating the member; instead, they’re explaining a health condition in relatable ways, contextualizing a treatment plan, and helping the member understand holistic considerations including risks and opportunities within their local environment. Social workers are also available for any TDS call to provide support for significant in-the-moment SDOH needs. Similarly, pharmacists are available to address and brainstorm medication cost solutions when this is a cost barrier.
- EMOs transport top-quality expertise to underserved communities. Access to high-quality primary and specialty care varies greatly across the U.S. Our provider quality data assets and algorithms illuminate the zip codes and regions where it’s very challenging to find a physician who has the training, experience and exposure to clinical innovations to properly diagnose rare or highly complex conditions. Expert medical opinions and concierge referrals serve a powerful role in bringing the best clinical thinking to a member in any zip code in the U.S., at no cost to the member. Our staff physician plays the role of translator, ensuring that the insights from a world-renowned expert are understood, internalized and acted upon. If the next barrier in a care journey becomes the need to get an in-person appointment with a new hard-to-schedule physician, our care team will take care of this for the member.
1. Donabedian A. Aspects of Medical Care Administration: Specifying Requirements for Health Care. Cambridge MA: Harvard University Press; 1973