"In California, there are efforts to mobilize SDoH aggregated data to inform the larger community. How do we partner with available Helath Care Data to create a description for ROI and or evaluation? " -Daniel Bach
"I have been speaking with a lot of health plans in the U.S. who are trying these initiatives but they have no idea how to calculate ROI or run the evaluations. Is this relatively straightforward? Is there a resouce I can share with them?" -Melissa Majerol
Replies
Hi there - The ROI question in social determinants is not a straightforward one at all. The biggest three variables are:
1. who is paying (payor, at-risk system, etc.) - this is in turn driven by the particular reimbursement and risk adjustment policies at the state level.
2. how much the intervention costs: this varies based on different areas - transportation versus food versus housing
3. what data area available to run these calculations before, during, and after the "I" of ROI has been made
Check out an ROI calculator by the Commonwealth Fund (based on work by Victor Tabbush) - it's a step in the right direction, but ultimately I suspect it's too complicated for most people to use (at least, it was for me).
My perspective is that today we are stuck at a grant-funding phase for certain areas (like food, housing), while others (like transportation) have more of a business case driven by specific reimbursement policy (in the US, called "non emergency medical transport" or NEMT).
Several years ago the Administration for Children and Families let seven grants to states to pilot different programs to explore interoperability. Maryland chose to develop an ROI calculator among other deliverables. It can be found on the ACF website here: https://www.acf.hhs.gov/sites/default/files/assets/roi_rev.zip Other projects can also be found in this section. I'm curious whether you think about this tool. (It was developed by Dr. Harold Lehman from Johns Hopkins University School of Medicine who was one of SOC's partners in this work.
Also - Professor Len Nickols recently published an article about paying for SDOH in his "Wrong Pocker" article recently published on Health Affairs:
Here is the link to the paper: https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2018.0039
(copied from "Knowledge from the North" webinar) Daniel Bach shared,
https://map.healthyplacesindex.org/
Is just one mobilized data set.
Response (copied from "Knowledge from the North" webinar discussion) from Paul Omaha, NE,
The Social Determinants concept arose primarily as a contributing factor for the origins of various chronic illnesses. To date we really do not have a global set of definitions that are linked under around an overall-unifying concept of HEALTH. The origins of Social Capital began in the economics literature regarding the investment stategies that promote economic growth. The study of economic institutions by Elinor Ostrom identified Social Capital as Trust, Cooperation and Reciprocity that improves the management of a common pool resource (as in irrigation, forrest, fisheries). For healthcare, it is the portion of a public institution's budget devoted to healthcare. The portion of the USA economy devoted to health spending was 5% in 1960 and 18% in 2016.
Elinor Ostrom was an Nobel prize-winning economist who spent a life time studying the attributes of managing a common pool resource. The best summary of her voluminous research can be found on URL address below. The best ROI research for Social Determinant research is in the arena of disaster mitigaton. The ROI is variably @4:1. The best research focused on the rebuilding projects for two communities on the east coast of Japan following the tsumami disaster in 2012. Very insightful. I would advise everyone that social capital investments are unlikely to achieve robust ROI without community promoted and sustained (as in generational) processes. The best example of this in the US are the Cooperative Extension Service offices establish by Congress in 1914. This commitment was implemented, county by county, nationally to promote a link between the local urban and rural farms with their State's nationally supported university based, College of Agriculture. Interestingly, the US agriculture industry is the most efficient and effective among the world's advanced nations by a very wide margin. Our healthcare industry is... (you got it)!
For one person's attempt to connect a set of definitions for Caring Relationships, Collective Action, Community, Family, HEALTH, INSTITUTION, Social Capital and SURVIVALCOMMONS see the second URL below.
http://dx.doi.org/10.1026/j.jebo.2012.12.010 ; (Professor Ostrom's last publication before she died in 2012)
https://nationalhealthusa.net/paradigm-shift/rationale/ ; (Note: see pages 4 thru 10)