PITTSBURGH, PA – ProspHire announced today that it ranks #4307 on Inc. Magazine’s annual list of America’s Fastest-Growing Private Companies – the 2023 Inc. 5000. The rank reveal also put ProspHire at #19 in Pittsburgh, #132 in Pennsylvania and #516 in the nation for business products and services. The list represents a unique look at the most successful companies within the U.S. economy’s most dynamic segment – independent, small businesses. ProspHire, a national healthcare consulting firm, is recognized for its rapid revenue growth while navigating inflationary pressure, the rising costs of capital and hiring challenges. In the history of Inc. 5000, only 5% of companies have made the list 4 times.
“Making the Inc. 5000 list is a huge honor that we credit to our employees,” said Lauren Miladinovich, Managing Principal and CEO of ProspHire. “The hard work and dedication from across all departments is the reason for our success and growth.”
Chris Miladinovich, ProspHire’s Principal and Chief Strategy Officer, said, “Being recognized with innovative and high growth companies across the U.S. for the 4th consecutive year is an accomplishment that we celebrate. This accolade showcases not just our success but demonstrates resilience though the threat of economic downturn, labor shortages and lasting impact of Covid-19.”
“Thank you to all our team members and clients for helping ProspHire reach this incredible milestone,” says Dan Crogan, Principal and SVP of Consulting. “Our dedication to the healthcare industry and our focus on project execution has enabled us to develop and maintain genuine partnerships with our clients where we act as an extension of their team to help them solve their most significant people, process and technology challenges.”
Complete results of the Inc, 5000, including company profiles and an interactive database that can be sorted by industry, region and other criteria can be found at www.inc.com/inc5000.
What is the difference between health equity and SDOH?
Imagine a scene where an elderly individual, a young adult and a disabled child are all provided the same level of care – that is health “equality”. Health “equity” focuses on providing unique unequal care to each individual to ensure the care they receive will result in the appropriate, desired and equal outcome. Now, taking the scene one step further, imagine the disabled child we are caring for has limited access to food at home, does not have housing that can accommodate a wheelchair and the family has minimal income. The barriers that this child faces due to the conditions in which they are born, grow, live and age, are social determinants, or drivers, of health (SDOH).
Why is addressing the role of SDOH important?
Recent studies show that SDOH can account for approximately 80% of an individual’s health. As providers, payors and supporting organizations, it simply makes sense to provide care that addresses the 80%, despite most of our efforts traditionally focusing on the other 20%. SDOH disproportionately impacts our underserved communities, which ultimately drives us toward additional discussion and consideration of health equity.
What are clients’ biggest challenges related to SDOH?
Although SDOH is no longer a new concept and our clients understand the importance of addressing SDOH, there is still a question of how. Understanding how to implement effective interventions, quantitatively assess SDOH needs, plan for a return on investment and identify partnerships for success, all pose challenges.
What health equity issues are clients focused on today?
Health equity is a major area of focus generally for many of our clients, but today, the greatest area of focus is maternal and perinatal health equity. Inequities in maternal and perinatal health have been prevalent for some time, and unfortunately the pandemic has exacerbated some of these inequities. Many of our clients are interested in improving equity among women of color and women in rural communities. In both cases, there is a need for improved access to and quality of care. From organizational interventions to community-based partnerships, we are supporting our clients to implement strategies that best meet the needs of their most vulnerable populations.
What are CMS’s new SDOH quality measures?
CMS implemented new SDOH quality measures in their 2023 IPPS Final Rule that will be voluntary in 2023 and required in 2024. These new measures are mandated for hospitals reporting to the Inpatient Quality Reporting (IQR) program and both focus on SDOH. Separate from the existing Z-codes, these measures are flexible in their collection and give hospitals the opportunity to self-select their screening method. The two measures “SDOH-1” and “SDOH-2” have separate goals.
“SDOH-1” focuses on the rate of screening. Simply put, what percent of patients admitted to the hospital were screened for SDOH based on the five assigned domains: food insecurity, housing instability, transportation needs, utility difficulties and interpersonal safety. “SDOH-2” focuses on these domains and captures the percent of admitted patients that screen positive for any of the five SDOH domains.
Previously, CMS issued guidance to support states in addressing SDOH in Medicaid and the Children’s Health Insurance Program (CHIP) in 2021. Health plans and providers alike can continue to expect increased SDOH guidance and measures in the future.
What is SDOH 101 for health care providers who need to get started on practice improvement?
Start small and be selective! Understanding your population and the subset of individuals who may be experiencing disparate outcomes due to health inequities or a specific SDOH domain offers an opportunity to pilot a solution and measure effectiveness. One key consideration in following this method is considering the population’s location. An intervention in one community may not work in another and addressing SDOH regionally with consideration to local barriers, needs and partnership opportunities will increase the likelihood of success. Additionally, don’t feel the need to start from scratch; there are several proven strategies to address SDOH that can inspire your future work.
What is the risk of not screening patients, assessing conditions and implementing change?
Now that there is an understanding of the true impact of SDOH on an individual’s health, not screening patients, assessing conditions and implementing change is equivalent to not looking under the hood of a car during an inspection and only looking at the car’s physical appearance. SDOH are underlying conditions that directly affect an individual’s health outcomes and are a key consideration to their treatment plan. Whether it be a mechanic and their car or a provider and their patient, we don’t want to send “patients” home without an understanding of how they may operate once they leave the safety of our care. It is the responsibility of the healthcare industry to implement change in the interest of our most vulnerable populations, so when they do leave our care, we have an understanding and care plan to ensure the right supports are available at home and in the community.
Do you have any predictions for Health Equity and SDOH in 2023?
During and following the height of the COVID-19 pandemic, we saw the influence of SDOH and the disproportionate impact of the pandemic on individuals already facing barriers in relation to social determinants and the importance of community-based care and support. As economic instability is expected through 2023, I would expect to see this trend continue, but this time around there may be more limited resources to support our community-based partners. This will open the door for providers and payors to collaborate and increase their engagement in SDOH intervention. Ultimately, SDOH and health equity are tightly intertwined and with magnification on equitable outcomes, this offers an opportunity to intervene.
How can ProspHire help?
ProspHire has always been in the business of assessing, understanding and implementing change across the healthcare industry. Through regional data assessments, understanding your patient population, evidence-based methodologies and community-based partnerships, ProspHire is equipped to support strategy development, intervention implementation and drive change within your organization. As you begin to explore opportunities to effectively address health equity and SDOH impact, we hope you will include us in your journey as we bring an industry and subject matter understanding to the forefront of our work.
What is Vendor Management as a Service Solution in the Healthcare Industry?
Vendor management as a service solution is providing healthcare organizations with best-practice strategies to optimize management of third-party vendors by streamlining vendor management workflows, reducing vendor costs and improving compliance with regulatory requirements.
We offer our clients a range of vendor management services, including vendor selection, contract management strategies, performance monitoring KPI definition, risk assessments and compliance monitoring. By utilizing a collaborative partner for these functions, healthcare organizations can free up internal resources focused on these efforts, reduce costs associated with vendor contracts, and improve the quality of their vendor management processes.
Are there industry regulations around vendor management?
Vendor management is critical to ensure ongoing patient safety, regulatory compliance and operational efficiency. In healthcare, the Centers for Medicare & Medicaid Services (CMS), the Office of Inspector General (OIG) and the Joint Commission have published guidelines regarding vendor management practices. CMS requires healthcare organizations to have written policies and procedures for selecting and managing vendors, including risk assessments and ongoing monitoring of vendor performance. OIG emphasizes the need for proper due diligence before selecting a vendor, which includes a qualitative and quantitative process that should lead to a decision that best fits the needs of the healthcare organization.
The Joint Commission includes vendor management as a standard for medical equipment and facility management. In addition to regulatory requirements, many healthcare organizations also have their own internal operating procedures for vendor management. These standard operating procedures may include requirements for vendor selection, contract management and ongoing vendor performance management.
Why is coordinating services from multiple vendors so important?
In healthcare, there are many vendors that provide products and services that need to work together to support patient care. Ensuring interoperability between these vendors will help them work better together. Coordinating services from multiple vendors can help with reducing duplicate efforts and resources, which often results in reduced costs. Improving communication between vendors leads to better outcomes for a patient and a better customer experience in the often-confusing world of consumerism in healthcare. By streamlining the vendor management process, most healthcare organizations find they can reduce the number of vendors they need and will consolidate to critical mass in order to “get it done” the right way.
Where does innovation fit into vendor management?
Innovation can play an important role in vendor management, especially as technology and other advancements continue to shape the way products and services are developed and delivered in the healthcare industry.
Here’s where I see recent innovation fitting into the vendor management process:
Identifying innovative vendors: Vendor management involves selecting and managing vendors who can provide products and services that meet the needs of the healthcare organization. Innovation can be an important factor in selecting vendors who can provide cutting-edge solutions and stay ahead of industry trends.
Collaborating with vendors on innovation: Healthcare organizations can collaborate with their vendors to develop new products and services that can improve patient care and drive operational efficiencies. By fostering innovation in their vendor relationships, healthcare organizations can stay at the forefront of industry trends and maintain a competitive edge.
Incorporating innovative solutions into vendor management processes: Healthcare organizations can leverage innovative technologies and solutions to streamline their vendor management processes, automate tasks and improve data analytics.
Adapting to new technologies and industry changes: As new technologies and industry trends emerge, healthcare organizations must adapt their vendor management processes to stay up-to-date. By embracing innovation and being open to new ideas, healthcare organizations can stay agile and responsive to industry changes.
How Can ProspHire Help?
ProspHire’s Vendor Management Office team has extensive experience in assessing current processes, identifying the gaps and developing a centralized VMO operating model strategy. That may include identifying cost saving measures and formalizing vendor management from selection to onboarding processes. We have also helped clients in developing custom analytical dashboards to monitor critical KPIs to keep our clients compliant with regulations and monitor overall vendor spend to ensure value is achieved.
Connect with us today to start talking about how we can partner with you to improve your vendor management.
With the final release of Star Year (SY) 2024 data coming in October, plans should expect a slow release of data to health plans in the period leading up to that date. One of the first big data releases included Members Choosing to Leave the Plan Part C and Part D measure data. CMS has also released information to plans to indicate that potential data errors occurred for some contracts and that an investigation into performance should be conducted.
The second data release contained the publishing of contract level CAHPS data in HPMS. This CAHPS data also includes cut points for each measure. The ProspHire Medicare Stars team reviewed and analyzed the movement from Star Year 2023 to Star Year 2024.
CMS will continue to release data to plans via HPMS: Plan Preview #1, Plan Preview #2 and the final public data release in early October. Health Plans should quickly review data as it is released to validate its accuracy. They also should utilize that data to better inform their contract’s overall SY24 projection. It would benefit Stars leaders to ensure that their senior leadership team is aware of projections in advance of the final release.
If you are not satisfied with your contracts Stars performance and require a refreshed approach to Stars performance improvement, the Medicare Stars team at ProspHire can partner with you to create a strategy moving forward and execute on your behalf.Connect with our experts today.
In the healthcare industry, operational efficiency is crucial for providing high-quality patient care, reducing costs and improving overall organizational performance. With healthcare costs continuing to rise, organizations must find ways to improve efficiency and reduce waste without compromising patient care.
We will explore some practical tips and strategies for improving operational efficiency in healthcare. By implementing these tips, healthcare organizations can streamline their operations, improve patient outcomes and position themselves for long-term success in a rapidly changing industry.
What Is Operational Efficiency?
Operational efficiency refers to the ability of an organization to produce goods or services with the minimum amount of resources and waste possible. In other words, it is the ratio of output to input in terms of time, money and resources.
Operational efficiency can be achieved by optimizing the processes and systems that are involved in producing a product or service. This includes:
Improving the efficiency of workflows
Minimizing waste and errors
Reducing costs
Maximizing productivity
In healthcare, operational efficiency is particularly important, as it can have a significant impact on patient outcomes. By optimizing processes, healthcare providers can improve patient flow, reduce wait times and help patients receive high-quality care in a timely manner. Overall, operational efficiency is a key factor in helping healthcare providers deliver high-quality care in a cost-effective manner.
Overview of Process Optimization in Healthcare
Process optimization is a key aspect of improving operational efficiency in healthcare. It involves identifying opportunities for improvement in the processes and workflows used in delivering patient care and making changes to optimize those processes.
The goal of process optimization is to reduce waste, improve patient outcomes and increase efficiency. By analyzing the way healthcare organizations operate, it is possible to identify areas where processes can be streamlined, standardized or automated through these methods:
Using technology: One key aspect of process optimization in healthcare is the use of technology. Electronic health records (EHRs), telemedicine and other digital tools can help automate processes, reduce errors, and improve communication and collaboration among healthcare providers.
Optimizing workflows: Another aspect of process optimization is optimizing workflows. This involves identifying the steps involved in a particular process and determining how those steps can be streamlined or eliminated to improve efficiency. For example, by standardizing processes for admitting patients, hospitals can reduce the time it takes to get patients into a room and receiving care.
Reducing administrative burdens: Administrative burdens can also be reduced through process optimization. By simplifying administrative tasks, such as billing and insurance claims, healthcare providers can reduce the time and resources needed for these tasks, freeing up more time to focus on patient care.
Why Process Optimization in Healthcare Is Important
Process optimization is essential in healthcare for a variety of reasons. Here are some key reasons why:
Improved patient outcomes: Process optimization can lead to improved patient outcomes. By streamlining processes and reducing errors, healthcare providers can help patients receive the best possible care.
Increased efficiency: By optimizing processes, healthcare providers can increase efficiency, reducing wait times and improving patient flow. This can lead to better patient experiences and improved outcomes.
Cost savings: Process optimization can also result in cost savings for healthcare organizations. By reducing waste and increasing efficiency, healthcare providers can save money on staffing, supplies and other resources.
Better resource allocation: Process optimization can help healthcare organizations allocate their resources more effectively. By identifying areas where resources are being underutilized or overutilized, healthcare providers can allocate resources more efficiently.
Improved compliance: By optimizing processes, healthcare organizations can work to be in compliance with regulations and standards. This can help to avoid fines and penalties and protect the reputation of the organization.
Process optimization is essential in healthcare to offer patients high-quality care, use resources effectively and maintain efficient and effective operations.
Tips on How to Increase Operational Efficiency
Here are some ways to increase operational efficiency:
Standardize processes: Standardizing processes can help reduce variation and improve efficiency. By creating standard workflows, procedures and guidelines, healthcare providers can reduce errors and improve patient outcomes.
Use technology: Leveraging technology can help automate processes and reduce administrative burdens. EHRs, telemedicine and other digital tools can help healthcare providers communicate and collaborate more effectively, leading to increased efficiency.
Optimize workflows: Analyzing and optimizing workflows can show areas where processes can be streamlined, automated or eliminated. These changes can help reduce wait times, improve patient flow and increase efficiency.
Improve communication and collaboration: Effective communication and collaboration among healthcare providers can help to reduce errors, improve patient outcomes and increase efficiency. By using digital tools and other communication methods, healthcare providers can work more efficiently and effectively.
Continuously monitor and improve: Continuously monitoring and analyzing operational processes can help identify areas where further improvements can be made. By regularly evaluating and optimizing processes, healthcare providers can operate at peak efficiency.
Strategies for Healthcare Process Improvement
There are several strategies healthcare organizations can employ to improve their processes and drive better care at lower costs:
Implement evidence-based practices: Evidence-based practices are medical interventions that have been proven to be effective through rigorous scientific research. By implementing these practices, healthcare organizations can improve patient outcomes while reducing costs by avoiding unnecessary tests, procedures and treatments.
Focus on prevention: Preventive care can help address health issues early before they become more serious and require more expensive treatments. Healthcare organizations can encourage patients to adopt healthy lifestyles and provide preventive services, such as screenings and vaccinations.
Reduce waste and inefficiency: Healthcare organizations can reduce waste and inefficiency by improving processes such as inventory management, reducing wait times and eliminating unnecessary tests or procedures.
Collaborate with other providers: Collaborating with other healthcare providers, such as hospitals and primary care providers, can improve care coordination and reduce duplication of services, which can lead to lower costs.
Engage patients: Engaging patients in their own care can improve outcomes and reduce costs. Healthcare organizations can provide education and resources to help patients manage their conditions and make informed decisions about their care.
How ProspHire Can Help
ProspHire is a healthcare management consulting firm that specializes in helping healthcare organizations optimize their operations and improve performance. Here are some ways we can help improve operational efficiency in healthcare:
Process optimization: We can help healthcare organizations identify opportunities for process optimization and implement changes to streamline workflows, reduce waste and increase efficiency.
Technology optimization: We can help healthcare organizations optimize their technology infrastructure, including EHRs, telemedicine and other digital tools, to improve communication, automate processes and reduce administrative burdens.
Performance improvement: We can help healthcare organizations improve their performance by setting performance goals, tracking progress and making changes to improve performance over time.
Change management: We can help healthcare organizations manage change effectively by communicating changes to staff, training staff on new processes and technologies and supporting staff through the change process.
Interim management: We can provide interim management services to help healthcare organizations maintain continuity of operations during times of transition or change.
By leveraging our expertise, your healthcare organization can optimize your operations, reduce waste and improve patient outcomes. Connect with us today to learn more about how we can help.
Season 1, Episode 2 of the Soaring to New Health Podcast
This episode is Ask the Next Generation Pharmacist. We talk with ProspHire’s Mark Thomas, an experienced pharmacist and consultant in the healthcare industry and Chris Antypas, a seasoned pharmacist, executive owner and innovator, about the pharmacist’s rapidly change role, the new ways to deliver patient care and the evolvement of medication management.
Today, pharmacy is at the forefront of many conversations. Drug costs are rising at an unprecedented rate. Employers and employer sponsored plans are trying to navigate and tackle pharmacy costs; and health plans are trying to zero in on how to contain costs while also ensuring access to innovative therapies.
On the innovation side, drug manufacturers continue to bring novel and rare disease therapies to the market. This, while the payer side is addressing rising drug costs and trying to navigate how to continue to afford to pay for medications and ensure access. Plus, billionaire business owner Mark Cuban is on a mission to “disrupt” the pharmaceutical Industry and sell low-cost prescription drugs directly to Americans.
Antypas says, “We spend a lot of time talking about healthcare costs and unfortunately what I’m seeing is there’s really not been enough attention put on the role that medications play in managing total cost of care”. His personal journey in trying to disrupt healthcare and improve healthcare is focused on the relationship with his patients – knowing who they are, understanding their personal situation and providing them with meaningful solutions to access or afford a medication. You’ll find that relationship-based care blended with a custom pharmacy experience at Antypas’s Asti Pharmacy in Pittsburgh’s South Hills area. Adherence packaging is an example of this care model, where the patient receives a customized blister pack containing all their daily medications.
In the digital heath and technology space, Antypas’s Perigon Pharmacy, umbrellaed under Perigon Health 360, a 50-state licensed, dual accredited specialty pharmacy that is creating tools for patients to help them take their medications more accurately and effectively. One such device sits on a countertop in the patients’ home and intelligently dispenses medication. This intersection of healthcare and innovation optimizes the care team’s ability to track and monitor whether the patient appears to have missed a dosage and then sends reminder notifications via text message or phone call. It’s at that point the pharmacist can connect with the patient to determine the cause and a solution.
The opportunity for health plans is to view pharmacy as a strategy to address any healthcare gaps and help manage member health. Thomas talks about the opportunity for the next generation pharmacist to think differently and outside of the box when it comes to drug delivery models. Antypas says those new ideas and pathways to success are built from being brave and having the courage to advocate and make a difference in a patient’s life. To hear more about today’s pharmacy trends and what some pharmacists are doing to push the boundaries of the traditional pharmacy practice, download Soaring to New Health’s episode two, Ask the Next Generation Pharmacist here.
Welcome to Season 1, Episode 1 of the Soaring to New Health Podcast.
This episode is Don’t be a Pain in the ACA. ProspHire’s Affordable Care Act (ACA) experts, Caitlin Nicklow and Matt Dauffenbach, talk about what it is, why it’s important, the timeline for launching a plan, how to get started and the impact on health plans.
When we’re talking about ACA, we’re normally talking about the individual exchange. This is an insurance marketplace for those who don’t have employer sponsored health care and don’t qualify for Medicaid or Medicare. To obtain coverage, individuals log on to their state or federal exchange and you shop for health care. It’s as simple as that.
The ACA has benefitted both members and Health Plans. The biggest advantage for members is the essential health benefits that each plan must include. It’s a safeguard for members. When you shop for a plan, you know that each one has, at minimum, the same core benefits, including preventative care and emergency services. Health Plans benefit from launching ACA plans because it’s an opportunity to stay with a member through all the phases of their life. When health plans launch an ACA plan, it keeps that revenue stream within the organization. Those health plans also immediately benefited from the Medicaid Redetermination because those members could move from Medicaid to their ACA plan. If your health plan doesn’t have an ACA plan, there is still an opportunity to launch one because the Medicaid Regermination process is going to take a year to unwind. Open Enrollment for Plan Year 2024 will be key for members who shop around for plans and want to make a switch.
Health plans shouldn’t underestimate the time it takes to set up an ACA Plan. The timeline varies and it depends on whether you are a brand-new plan or a mature plan that has already obtained NCQA or URAC accreditation. That could mean the difference between 12 months and 18 to 24 months. At ProspHire, we tell our clients not to rush… plan out those processes, make sure you have the infrastructure to support the potential number of member growth.
Demographics and competition are important. You could have a plan that launches with 5,000 members and quickly grows to 50,000. Realistic short term and long-term goals are all a part of planning conversations. It’s important to understand what your strengths as a plan are, how strong your brand is and what differentiators will attract members.
Staying on top of ACA compliance and regulations can be a full-time job. At the foundation, the biggest requirement is Qualified Health Plan (QHP) certification. Any plan in the marketplace in any U.S. state must have this certification and you must renew it annually. The process looks at the bones of the operation of the plan, starting in May and wrapping up in September. In addition, every state will have their own specific requirements to operate in that state. Third is a must have – accreditation. That looks at the inside of the plan, the policies and procedures. Beware that NCQA or URAC is very time intensive and involves more than 100 requirements for the plan to be in compliance.
Prioritization is key when launching an ACA plan. During the assessment phase, we talk with you about competing projects and resources. We look for ways to align your priorities and leverage existing projects and resources in your organization to avoid duplication of efforts across multiple programs.
For more details on the challenges and solutions once the plan is established and enrollment period begins, download Soaring to New Health’s episode one, Don’t be a Pain in the ACA here.
As payers and providers continue to manage the impact of COVID-19 on their populations, social determinants of health (SDOH) remain a focus for improving population health. Addressing SDOH has become even more vital as the pandemic had a disproportionate effect on the most vulnerable populations who are also greatly impacted by SDOH-related issues. While it remains at the forefront of strategy across the healthcare industry, it is imperative that interventions targeting SDOH are measurable and evidence-based to draw insights into conclusive results. In doing so, organizations will be better equipped to implement successful SDOH initiatives driving improved health outcomes.
What Are the Key Areas of SDOH?
SDOH describes the conditions in which people are born, live, learn and play, among other things and impact a wide range of health, functioning and quality of life concerns.[1] The Centers for Disease Control has identified five key areas of focus including healthcare access and quality, economic stability, education access and quality, neighborhood and built environment, and social and community context.[2] There is consensus regarding the need for consideration of these factors when measuring health; however, success has been varied with decision makers often crafting solutions from afar and without local and member-level input or data to support their efforts. While traditional healthcare services remain vital to measuring health, it is only one piece in a complex web of factors that impact health costs and outcomes. Studies show that social determinants can have a greater impact than healthcare or lifestyle choices in influencing a person’s health with some showing that they can account for as much as 80% of health outcomes.[3] This includes food insecurity, job security, education, among others; however, efforts to address these issues have largely been unsuccessful. There are programs across the country targeting these various issues and it is important that they be measured for impact and success.
A common SDOH highlighting this issue is food security, defined as a household-level economic and social condition of limited or uncertain access to adequate food.[1] Food security can be temporary or long term and is influenced by various social factors including job security, disability and income, among others. When crafting interventions to target food security, it’s important to think broadly about the surrounding factors that influence it. Access to food is crucial, but so is consideration of the transportation needed to acquire that food (or lack thereof) and an intervention that targets food distribution without consideration of the related factors is doomed to fail. One organization working to address food security is Feeding America, which manages a nationwide network of food banks and other community-based agencies to feed more than 46 million people yearly.[2] The organization has developed a Framework to mitigate the implementation of unhelpful or unsuccessful interventions targeting food security[3]
Feeding America highlights the Supplemental Nutrition Assistance Program (SNAP) as an example of a ‘proven’ SDOH framework – one that has demonstrated consistent positive improvement to accessing healthy food through multiple studies. It has accomplished this through local networks of food banks, despite being a national program. This local approach allows for tailored outreach activities, utilizing community networks and unique language and cultural needs to deliver services that are useful for the communities needing it the most.[1]
Despite this, it is important to note that while the intervention itself may be evidence-based in its implementation, it is not immune to external factors that could limit its effectiveness. The framework also takes into account those conditions that could impact an intervention’s success such as the high cost of food. Considering the rising food prices in 2022, approximately 10% higher according to the USDA, this would have a direct impact on a program like SNAP’s success, as the benefits are not regularly adjusted to reflect variation in food costs or cost-of-living. Therefore, when evaluating an intervention on its effectiveness in addressing SDOH, it is imperative to remember that they don’t exist in isolation and are continuously impacted by our changing world.
There is a growing recognition that building strategies that incorporate SDOH are beneficial for both providers and payors. These initiatives provide opportunities to address population health needs in communities across the country, which can improve care for members while reducing costs, if done correctly. To accomplish this, it is essential that SDOH interventions be evidence-based and both collaborative and customized to local communities, enabling organizations to increase the effectiveness of their initiatives while improving care for the most vulnerable populations.
How Can ProspHire Help?
At ProspHire, we want to ensure your programs have the greatest impact on members and patients, while simultaneously addressing the disparities that exist across our communities. Our team’s extensive knowledge in this topic can help your organization optimize strategies and deliver effective programs that support the most vulnerable populations. We understand the challenges and solutions to drive change through social determinants with a focus on your unique member and patient needs. Reach out today for more information to partner in this important work.
Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Retrieved [May 18, 2023], from https://health.gov/healthypeople/objectives-and-data/social-determinants-health
https://www.rwjf.org/en/insights/our-research/2019/02/medicaid-s-role-in-addressing-social-determinants-of health
Social determinants of health (SDOH) are conditions in the environment that affect individuals’ wellbeing, quality of life and health outcomes. They are commonly grouped into domains that include economic stability, education access, healthcare access, living environment and social support. It is important to screen for these determinants in clinical settings because research shows that social determinants of health are linked to negative health outcomes. Standardizing screening tools and providing appropriate community-based resources to patients will help decrease negative health outcomes (Sokol, 2020).
The Institute of Medicine (IOM) recommends that screening tools include common domains such as educational attainment, financial status, social isolation and median income levels as social stability domains (National Academies of Sciences, Engineering, and Medicine, 2016). A review of the literature found that 70% of screening tools measure at least 8 out of the 15 recommended domains and that only 66% of the tools that were reviewed were commonly used in clinical practices (Meon et al., 2020). Although payers and providers recognize social determinants of health as a problem, organizations still struggle to implement and accurately report SDOH data. How can implementation be improved? What makes screening programs successful?
Source: Meon et al., (2020). A review of tools to screen for social determinants of health in the United States: A practice brief. Population health management, 23(6), 422-429.
Screening Tools and Barriers to Implementation
There are a wide range of screening tools being used in clinical settings to identify at-risk members. Common screening tools such as Health Leads and PRAPARE are used to assess and address patients’ social determinants of health.
Health Leads screens an individual for adverse social determinants across 13 social needs domains (Health Leads, 2019). The questionnaire is evidence-based and is used in clinical settings. PRAPARE is also a nationally standardized tool used to assess patients’ risks and experiences (PRAPARE, 2022). The standardization of both tools allows them to be easily used by practitioners and integrated into EHR platforms. Despite having standardized tools, without a standardized approach, providers struggle to accurately capture, report and provide appropriate community-based resources for their most vulnerable patients (Fitzhugh et al., 2021; Meon et al., 2020). Standardization is a challenge because tools screen across different domains and lack a common approach to measure duration of time that patients experience social determinants of health. Although these challenges exist, providers have found success by utilizing evidence-based screening tools and developing a community-based approach to provide patients with needed resources (Bleacher et al., 2019).
Health Plans Combatting Social Determinants of Health
University of Pennsylvania Medical Center (UPMC) implemented “Cultivating Health for Success”, a program that partners with community organizations to provide permanent housing to members (Sokol, 2020). The program saw a savings of $6,384 for each of their participating members. UPMC was able to identify their at-risk population and provide them with a permanent solution to better control their social environment and health outcomes. Since the initiation of this program, several other programs at UPMC have been implemented to combat social determinants of health.
The success of the initiatives at UPMC was driven by practitioners recognizing that social determinants of health are interconnected and the importance of screening and identifying at-risk members. By providing members with the necessary community-based resources, UPMC saw significant cost savings because members were better able to manage their health. UPMC also recognized that data collection is paramount to understanding the “full picture” of a member to drive change.
How ProspHire Can Help
The first step to addressing health disparities in your community and across patient or member populations is to understand the underlying drivers of health in your population. That understanding will allow you to execute targeted programming that positively impacts your patients and their health outcomes, driving cost savings related to these disparities. At ProspHire, we have the experience and skillset to help you take that first step. We can partner with your teams to help you implement strategies that drive health equity forward. Connect with us today to learn more.
Resources:
Bleacher, H., Lyon, C., Mims, L., Cebuhar, K., & Begum, A. (2019). The feasibility of screening for social determinants of health: seven lessons learned. Family Practice Management, 26(5), 13-19.
Health Leads Screening Toolkit. Health Leads. (2019). Retrieved April 20, 2022, from https://healthleadsusa.org/resources/the-health-leads-screening-toolkit/
Fitzhugh, C. D., Pearsall, M. S., Tully, K. P., & Stuebe, A. M. (2021). Social Determinants of Health in Maternity Care: A Quality Improvement Project for Food Insecurity Screening and Health Care Provider Referral. Health Equity, 5(1), 606-611.
Meon, M., Storr, C., German, D., Friedmann, E., & Johantgen, M. (2020). A review of tools to screen for social determinants of health in the United States: A practice brief. Population health management, 23(6), 422-429.
Sokol, E. (2020, January 29). How UPMC coordinates compounding social determinants of health. HealthPayerIntelligence. https://healthpayerintelligence.com/news/how-upmc-coordinates-compounding-social-determinants-of-health
PITTSBURGH, PA – ProspHire, a national healthcare consulting firm, is pleased to announce Co-founder and Principal, Chris Miladinovich, has been named the Firm’s first Chief Strategy Officer. In this new role, he is responsible for overseeing business development, client relationships, strategic partnerships and the Firm’s long-term strategic plan. Prior to this, Chris was ProspHire’s Chief Operating Officer in charge of the operational business units, including Finance, IT and Administrative Operations.
“I am ecstatic for the opportunity to take on this new role. ProspHire has an incredible culture that has led to tremendous growth all with an eye on improving the client experience,” said Chris Miladinovich. “My passion has and always will be to help our people and our clients succeed. Today our clients are searching for innovative solutions for their complex healthcare problems and we are focused on helping them improve their organizations in order to help their healthcare members.”
Chris brings over 20 years of experience leading large-scale, complex business transformation programs from a billion dollar, Big 4, consulting organization to an emerging business. His leadership has been focused on developing and delivering technology-driven business services and solutions in the healthcare industry and he has been responsible for managing over $20 million in annual revenue, providing outstanding client experiences and driving profitable growth.
“We are excited to have Chris take on this new role as he brings an invaluable blend of industry experience and execution,” said Lauren Miladinovich, ProspHire’s Co-founder, Managing Principal and Chief Executive Officer. “With his extensive knowledge, industry partnerships and strategic vision, Chris has stood by my side leading and growing ProspHire since 2015. We look forward to achieving that same level of success as he executes on ProspHire’s long-term strategy in the years ahead.”
Chris and Lauren have recently been named Entrepreneur of the Year® 2023 East Central Finalists.
