SDOH: An Untapped Profit Center
Town Square's mission is to revolutionize the way vulnerable populations access social care, by creating a connected ecosystem of healthcare and social care organizations to make whole person health a reality in every community.
Town Square provides cost-effective, turn-key social care coordination for members with health-related social needs. By leveraging the existing support of your local community, Town Square programs improve member engagement, screen for and meet social needs, and close targeted gaps in care.
Health plans improve quality and member health. CBOs benefit from sustainable partnerships with aligned incentives.
While SDOH programs are better understood in 2024 than they were a few short years ago, they are still often perceived as a significant cost center with loose correlation to reductions in total cost of care and only relevant for a small number of the highest risk members.
Town Square has a different perspective. Today, we dive into frequently asked questions in the social care space to better illuminate new opportunities and misconceptions related to SDOH.
What is the biggest misconception of SDOH?
Our lens is too narrow. I think SDOH is often still framed as a handout for niche populations. Last year, 43% of all Americans had at least one unmet social need. 68% of seniors had unmet social needs. 72% of Americans lack retirement savings. 52% of employees have one or both parents living with them (up from 38% in 2000). Food prices are up. Gas and transportation prices are up. Interest rates are high and wages are stagnant. This climate is putting tremendous pressure on Americans, especially seniors, forcing them to make trade offs that negatively impact their health.
We have to start with the understanding that SDOH needs are very, very prevalent.
Thinking about SDOH as a “total cost of care” issue narrows our understanding of its potential – social care is a formidable lever to drive consumer loyalty, engagement and growth, as well as health and equity. Being there and helping to solve a member's social needs during their most vulnerable moments is a very powerful opportunity to build trust and loyalty, and better health.
How has the adoption of SDOH in Medicare Advantage changed over time?
Over half of eligible Medicare beneficiaries now have Medicare Advantage (MA). A large part of MA’s growth has been attributed to low cost health benefits and a growing number of supplemental benefits including vision, dental, gym membership, an OTC card, etc.
However, given the current reimbursement rates, many plans are publicly stating they intend to pull back on benefits. At the same time, consumer demand for social care supports is higher than ever. Furthermore, CMS has initiated a new Health Equity Index bonus payment starting in 2025 that will swing Star ratings by up to 0.4 points. For the first time, a significant portion of a health plan’s Star Rating will be driven by their performance among members who have social risk factors.
With high competition for member growth and retention, savvy health plan leaders will take the opportunity to recalibrate to this new market. The second wave of growth in MA will be driven by more personalization and tailored social service support.
What are the challenges for insurers in deploying these expanded services?
The expansion of tailored SDOH services and social care coordination creates administrative challenges for insurers. As they add more services, the complexity of delivering them also increases.
For elderly individuals, chronic conditions and social needs like income, health status and living situations can change quickly, so plans need to have a regular, trusted connection to their members. But it is not cost-effective for plans to use their traditional care management team to scale SDOH services.
At the same time, because social services are often delivered locally, health plans would have to manage a significantly larger fragmented network of vendors and social care organizations. This is especially a challenge for regional and mid-sized plans. Scaling these operations will require investment, but not making the investment will leave them further behind the competition as members find the support they need elsewhere.
How is Town Square working to solve these challenges?
We are bringing to market a turn-key solution for health plans that lowers administrative costs to deploy social care coordination while improving member experience, retention and health outcomes.
Town Square provides wrap-around services and technology to help facilitate partnerships between community based organizations and healthcare organizations.
Our local teams of tech-enabled Community Health Workers forge longitudinal relationships with members, building trust and reciprocity by leading with social care. They screen member social needs, guided closed-loop referrals, and close targeted care gaps, driving member satisfaction and health outcomes. We also build networks of high-performing social care networks tailored to member and market needs that are managed by our team and paid for performance, ensuring services are delivered. Our technology enables us to streamline processes, increase efficiency and standardize member-level SDOH data for greater visibility into performance and gaps in services, and to meet compliance reporting needs.
Closing Thoughts
Imagine being an elderly individual, having lived a life full of hard work and contribution. Age brings challenges like loneliness, chronic illness and home maintenance issues, but a health plan designed for seniors can change that. We create a support system that honors the unique journeys of our seniors and lets them know that their well-being truly matters. In-network social service organizations become companions, bringing warmth and assistance. They deliver meals, ease grocery shopping, and maintain homes – lifting burdens and breaking isolation. The impact is profound. Mobility is regained, outings are possible and safe homes offer security. Coordinated social care isn't just health services, it also restores dignity, enabling seniors to live and age more gracefully.