Concerns about the opportunity costs of social screening initiatives have led some healthcare organizations to consider using social deprivation indices (area-level social risks) as proxies for ...self-reported needs (individual-level social risks). Yet, little is known about the effectiveness of such substitutions across different populations.
This analysis explores how well the highest quartile (cold spot) of three different area-level social risk measures-the Social Deprivation Index, Area Deprivation Index, and Neighborhood Stress Score-corresponds with six individual-level social risks and three risk combinations among a national sample of Medicare Advantage members (N=77,503). Data were derived from area-level measures and cross-sectional survey data collected between October 2019 and February 2020. Agreement between individual and individual-level social risks, sensitivity values, specificity values, positive predictive values, and negative predictive values was calculated for all measures in summer/fall 2022.
Agreement between area and individual-level social risks ranged from 53% to 77%. Sensitivity for each risk and risk category never exceeded 42%; specificity values ranged from 62% to 87%. Positive predictive values ranged from 8% to 70%, and negative predictive values ranged from 48% to 93%. There were modest performance discrepancies across area-level measures.
These findings provide additional evidence that area-level deprivation indices may be inconsistent indicators of individual-level social risks, supporting policy efforts to promote individual-level social screening programs in healthcare settings.
Little information exists to inform stakeholders' efforts to screen for, address, and risk-adjust for the health-related social needs (HRSNs) of Medicare Advantage (MA) enrollees, particularly those ...not dually Medicaid-Medicare eligible and those younger than age sixty-five. HRSNs can include food insecurity, housing instability, transportation issues, and other factors. We examined the prevalence of HRSNs in 2019 among 61,779 enrollees in a large, national MA plan. Although HRSNs were more common among dual-eligible beneficiaries, with 80 percent reporting at least one (average, 2.2 per beneficiary), 48 percent of non-dual-eligible beneficiaries reported one or more, indicating that dual eligibility alone would have inadequately captured HRSN risk. HRSN burden was unequally distributed across multiple beneficiary characteristics, notably with beneficiaries younger than age sixty-five more likely than those ages sixty-five and older to report having an HRSN. We also found that some HRSNs were more strongly associated with hospitalizations, emergency department visits, and physician visits than others. These findings suggest the importance of considering the HRSNs of dual- and non-dual-eligible beneficiaries, as well as those of beneficiaries of all ages, when exploring how to address HRSNs in the MA population.
Among older adults enrolled in Medicare Advantage, health-related social needs are highly prevalent, with financial strain, food insecurity, and poor housing quality the most commonly reported. The ...distribution of health-related social needs is uneven, with significant disparities according to race, socioeconomic status, and sex.
Importance There is increased focus on identifying and addressing health-related social needs (HRSNs). Understanding how different HRSNs relate to different health outcomes can inform targeted, ...evidence-based policies, investments, and innovations to address HRSNs. Objective To examine the association between self-reported HRSNs and acute care utilization among older adults enrolled in Medicare Advantage. Design, Setting, and Participants This cross-sectional study used data from a large, national survey of Medicare Advantage beneficiaries to identify the presence of HRSNs. Survey data were linked to medical claims, and regression models were used to estimate the association between HRSNs and rates of acute care utilization from January 1, 2019, through December 31, 2019. Exposures Self-reported HRSNs, including food insecurity, financial strain, loneliness, unreliable transportation, utility insecurity, housing insecurity, and poor housing quality. Main Outcomes and Measures All-cause hospital stays (inpatient admissions and observation stays), avoidable hospital stays, all-cause emergency department (ED) visits, avoidable ED visits, and 30-day readmissions. Results Among a final study population of 56 155 Medicare Advantage beneficiaries (mean SD age, 74.0 5.8 years; 32 779 58.4% women; 44 278 78.8% White; and 7634 13.6% dual eligible for Medicaid), 27 676 (49.3%) reported 1 or more HRSNs. Health-related social needs were associated with statistically significantly higher rates of all utilization measures, with the largest association observed for avoidable hospital stays (incident rate ratio for any HRSN, 1.53; 95% CI, 1.35-1.74;P < .001). Compared with beneficiaries without HRSNs, beneficiaries with an HRSN had a 53.3% higher rate of avoidable hospitalization (incident rate ratio, 1.53; 95% CI, 1.35-1.74;P < .001). Financial strain and unreliable transportation were each independently associated with increased rates of hospital stays (marginal effects of 26.5 95% CI, 14.2-38.9 and 51.2 95% CI, 30.7-71.8 hospital stays per 1000 beneficiaries, respectively). All HRSNs, except for utility insecurity, were independently associated with increased rates of ED visits. Unreliable transportation had the largest association with increased hospital stays and ED visits, with marginal effects of 51.2 (95% CI, 30.7-71.8) and 95.5 (95% CI, 65.3-125.8) ED visits per 1000 beneficiaries, respectively. Only unreliable transportation and financial strain were associated with increased rates of 30-day readmissions, with marginal effects of 3.3% (95% CI, 2.0%-4.0%) and 0.4% (95% CI, 0.2%-0.6%), respectively. Conclusions and Relevance In this cross-sectional study of older adults enrolled in Medicare Advantage, self-reported HRSNs were common and associated with statistically significantly increased rates of acute care utilization, with variation in which HRSNs were associated with different utilization measures. These findings provide evidence of the unique association between certain HRSNs and different types of acute care utilization, which could help refine the development and targeting of efforts to address HRSNs.
Recent research highlights the association of social determinants of health with health outcomes of patients with type 2 diabetes (T2D).
To examine associations between health-related social needs ...(HRSNs) and health care quality and utilization outcomes in a Medicare Advantage population with T2D.
This cross-sectional study used medical and pharmacy claims data from 2019. An HRSN survey was given between October 16, 2019, and February 29, 2020, to Medicare Advantage beneficiaries. Inclusion criteria were diagnosis of T2D, age of 20 to 89 years, continuous Medicare Advantage enrollment in 2019, and response to the HRSN survey. Data were analyzed between June 2021 and January 2022.
Enrollment in Medicare Advantage, diagnosis of T2D, and completion of a survey on HRSNs.
Quality outcomes included diabetes medication adherence, statin adherence, completion of a glycated hemoglobin (HbA1c) laboratory test in the past 12 months, and controlled HbA1c. Utilization outcomes included all-cause hospitalization, potentially avoidable hospitalization, emergency department discharge, and readmission.
Of the 21 528 Medicare Advantage beneficiaries with T2D included in the study (mean SD age, 71.0 8.3 years; 55.4% women), most (56.9%) had at least 1 HRSN. Among the population with T2D reporting HRSNs, the most prevalent were financial strain (73.6%), food insecurity (47.5%), and poor housing quality (39.1%). In adjusted models, loneliness (odds ratio OR, 0.85; 95% CI, 0.73-0.99), lack of transportation (OR, 0.80; 95% CI, 0.69-0.92), utility insecurity (OR, 0.86; 95% CI, 0.76-0.98), and housing insecurity (OR, 0.78; 95% CI, 0.67-0.91) were each associated with lower diabetes medication adherence. Loneliness and lack of transportation were associated with increased emergency visits (marginal effects of 173.0 95% CI, 74.2-271.9 and 244.6 95% CI, 150.4-338.9 emergency visits per 1000 beneficiaries for loneliness and transportation, respectively). Food insecurity was the HRSN most consistently associated with higher acute care utilization (marginal effects of 84.6 95% CI, 19.8-149.4 emergency visits, 30.4 95% CI, 9.5-51.3 inpatient encounters, and 17.1 95% CI, 4.7-29.5 avoidable hospitalizations per 1000 beneficiaries).
In this cross-sectional study of Medicare Advantage beneficiaries with T2D, some HRSNs were associated with care quality and utilization. The results of the study may be used to direct interventions to the social needs most associated with T2D health outcomes and inform policy decisions at the insurance plan and community level.
Payers are increasingly using approaches to risk adjustment that incorporate community-level measures of social risk with the goal of better aligning value-based payment models with improvements in ...health equity.
To examine the association between community-level social risk and health care spending and explore how incorporating community-level social risk influences risk adjustment for Medicare beneficiaries.
Using data from a Medicare Advantage plan linked with survey data on self-reported social needs, this cross-sectional study estimated health care spending health care spending was estimated as a function of demographics and clinical characteristics, with and without the inclusion of Area Deprivation Index (ADI), a measure of community-level social risk. The study period was January to December 2019. All analyses were conducted from December 2021 to August 2022.
Census block group-level ADI.
Regression models estimated total health care spending in 2019 and approximated different approaches to social risk adjustment. Model performance was assessed with overall model calibration (adjusted R2) and predictive accuracy (ratio of predicted to actual spending) for subgroups of potentially vulnerable beneficiaries.
Among a final study population of 61 469 beneficiaries (mean SD age, 70.7 8.9 years; 35 801 58.2% female; 48 514 78.9% White; 6680 10.9% with Medicare-Medicaid dual eligibility; median IQR ADI, 61 42-79), ADI was weakly correlated with self-reported social needs (r = 0.16) and explained only 0.02% of the observed variation in spending. Conditional on demographic and clinical characteristics, every percentile increase in the ADI (ie, more disadvantage) was associated with a $11.08 decrease in annual spending. Directly incorporating ADI into a risk-adjustment model that used demographics and clinical characteristics did not meaningfully improve model calibration (adjusted R2 = 7.90% vs 7.93%) and did not significantly reduce payment inequities for rural beneficiaries and those with a high burden of self-reported social needs. A postestimation adjustment of predicted spending for dual-eligible beneficiaries residing in high ADI areas also did not significantly reduce payment inequities for rural beneficiaries or beneficiaries with self-reported social needs.
In this cross-sectional study of Medicare beneficiaries, the ADI explained little variation in health care spending, was negatively correlated with spending conditional on demographic and clinical characteristics, and was poorly correlated with self-reported social risk factors. This prompts caution and nuance when using community-level measures of social risk such as the ADI for social risk adjustment within Medicare value-based payment programs.
Birds play an important role in modern and historic Puebloan ceremonialism, with feathers, wings, stuffed birds, and live birds used for ceremonies, sacrifices, and creation of ritual paraphernalia. ...Archaeological evidence suggests birds played an ideological and ritual role for some prehispanic Southwestern groups as well. Here, we explore the use of avian remains for ritual purposes at Pueblo Bonito by presenting new evidence from the northern burial cluster. Drawing on multiple quantitative measures, we establish the dissimilarity of this assemblage to other Chacoan sites. We demonstrate that an unusually wide variety of avian species was deposited in the northern burial cluster, particularly wing elements that may reflect wing fan deposition. These findings improve our understanding of ritual life at Pueblo Bonito and also show the utility of using both qualitative and quantitative data to create a more accurate understanding of past ceremonial activity.
Health-related social needs (HRSN), such as housing instability, food insecurity, and poor transportation or social support, adversely affect health. In diabetes, where evidence links health ...behaviors, which are influenced by social/environmental factors, to disease onset and progression, a deeper understanding of the degree to which specific HRSN, or multiple needs, affect health may be crucial to achieving one’s best health. HRSN for adults with Medicare Advantage coverage (n=33,690) who responded to an abridged version of the Accountable Health Communities screener developed by the Centers for Medicare and Medicaid Services were evaluated. Overall, 56% (n=18,925) of people with diabetes reported one or more HRSN. A higher percentage of people with diabetes screened positive for financial strain (47%), food insecurity (31%), and poor housing quality/safety (24%) compared to those without diabetes (38%, 24%, and 19%, respectively). As the HSRN burden increased, healthcare utilization and cost also increased while compliance with certain quality indicators decreased. Our findings highlight the interplay between clinical and social needs and indicate that an increased awareness and incorporation of patients’ HRSN into clinical care may be essential for achieving optimal health in patients with diabetes. As more practices move to value-based arrangements, data on HRSN, combined with proven interventions, will help drive better health outcomes.
Disclosure
S. Franklin: Employee; Self; Humana. A. Hagan: None. P. Hansen: Employee; Self; Humana. G. Haugh: Employee; Self; Humana. C. Long: Employee; Self; Humana.
Purpose
The purpose of this study was to assess whether a simple intervention could sustain new hires’ high engagement levels beyond the first six months. This case study illustrates how a simple ...intervention can extend the “job honeymoon“ – a brief period of high engagement – up to a year post hire.
Design/methodology/approach
This study reports the results of a randomized, controlled study in one organization using a “wise intervention,” a method derived from social science research in educational settings.
Findings
This case study illustrates that it is possible to extend the job honeymoon up to a year post-hire. Acknowledging to new hires that transitions are challenging produced a statistically significantly higher sense of belonging and higher employee satisfaction up to 9+ months post-hire.
Research limitations/implications
This work was inspired by research from Gregory M. Walton, and it illustrates the potential value for application in the workplace. However, its generalizability to all organizations will require further study.
Practical implications
This work is most relevant for human resources leaders and managers who want to ensure new hires are well supported. This study found that acknowledging the difficulty of a transition increases the engagement of new team members substantially and likely enhances productivity and team effectiveness for months to come.
Originality/value
The highly counterintuitive but critically important idea of this study is that people need reassurance that transitions might feel hard but are a shared experience. Providing that reassurance is a simple, easy-to-apply approach to support the newest members of a team or organization and sustain their engagement for months to come.
Research Objective
Health plans are among the many stakeholders seeking to improve health and reduce costs by screening and intervening on social determinants of health (SDOH). Humana Health Plan ...launched its Bold Goal Initiative in 2015 to test a novel approach for SDOH intervention not only at the individual patient level, but also at the community level through multi‐sector partnerships. We examined the community‐level effects of this initiative using data from a national, longitudinal survey of community health networks collected during 2012‐2018.
Study Design
The National Longitudinal Survey of Public Health Systems was used to measure networks of community organizations that work together in implementing health improvement activities in a national sample of U.S. communities. Changes in the network characteristics of Bold Goal communities were compared with a matched, synthetic comparison group of similar U.S. communities using difference‐in‐difference analysis focusing on the years before (2012‐2014) and after (2016‐2018) implementation. Data from each wave of the survey were linked with county‐level community characteristics from the Area Health Resource File, mortality data from the CDC Compressed Mortality File, and Medicare spending data from the Dartmouth Atlas of Healthcare. A new surrogate‐index methodology proposed by Athey, Chetty and colleagues was used with the full panel of network survey data from 1998‐2018 to estimate the possible long‐term effects of Bold Goal on mortality and medical spending over 10 years, using network measures as short‐term statistical surrogate variables.
Population Studied
The Bold Goal initiative was initially implemented in seven U.S. metropolitan areas with large concentrations of Humana members and employees: Baton Rouge, LA; Broward County, FL; Knoxville, TN; Louisville, KY; New Orleans, LA; San Antonio, TX; and Tampa Bay, FL. The synthetic control group was constructed from a national sample of 280 U.S. communities having at least 100,000 residents that were included in the National Longitudinal Survey of Public Health Systems.
Principal Findings
Cross‐sector network density increased by an average of 18.4 percentage‐points in Bold Goal Communities compared to 1.8 percentage points in the comparison group (p<0.01). Results were driven by large increases in network participation rates among employers, hospitals, health insurers, physicians, schools, and faith‐based organizations in the Bold Goal communities (all p<0.05). Surrogate index results indicated that the program could generate a 5.1 percentage point reduction in all‐cause mortality and a 6.4 percentage‐point reduction in Medicare spending per person in affected communities if network effects are maintained over 10 years.
Conclusions
A health plan‐sponsored initiative can stimulate substantial changes in community networks with the potential to benefit not only enrolled plan members but also the public at large.
Implications for Policy or Practice
The expanding array of SDOH screening and referral initiatives hold considerable health improvement potential, but only if community capacity to address unmet social needs can be strengthened commensurately. Results show that health plan engagement in community‐level SDOH initiatives are likely feasible and effective in strengthening community capacity and improving outcomes by expanding community networks. As such, insurers and other sponsors should consider expanded engagement in these initiatives as part of their SDOH strategies.
Primary Funding Source
The Robert Wood Johnson Foundation
