Your Best Outcome: Our Social Determinants of Life^® Strategy

Health care must be about more than medicine. The conditions in which people are born, live, learn, work, play, and age — factors outside the confines of clinical delivery systems — have a profound impact on health outcomes.

Our understanding of what drives overall well-being is increasingly being informed by the social determinants of health. These are factors such as food, shelter, transportation, health care, and social support, which have a direct impact on our ability to survive and thrive. This reality is why, at AmeriHealth Caritas, we refer to them as the social determinants of life (SDOL).

SDOL can contribute to health disparities and inequities when there are challenges with regard to the accessibility and availability of nutritious food, safe housing, reliable transportation, and quality health care. Promoting healthy choices and lifestyles is not enough to improve health outcomes for vulnerable populations. We must address the socioeconomic conditions creating barriers to life-sustaining resources.

Pathway to wellness and resilience

This a top priority in Medicaid delivery today and it is at the heart of our company’s Next Generation Model of Care. We take a whole-person approach to wellness and resilience by:

• Integrating physical and behavioral health, as well as pharmacy needs, into a holistic managed care program
• Collaborating with community-based organizations and other stakeholders to advance population health 
• Breaking down barriers to SDOL to help improve health outcomes
• Creating pathways for members to find a way out of poverty and live their American Dream

Partnerships and programs

Medical care is responsible for only 10% to 20% of health outcomes. The remaining 80% to 90% are rooted in social determinants.¹ Having conversations about SDOL-related challenges with patients requires a shift in the traditional health care delivery system. 

Still, our commitment to offering whole-person health care includes proactively helping providers connect patients with resources beyond traditional medical services. This includes:

• Developing ways to identify SDOL challenges through routine screenings
• Maintaining a database of community-based resources that we make available to providers
• Utilizing the provider portal to share member clinical summaries containing actionable data collected across multiple domains

To help close care gaps for particularly vulnerable members, our Let Us Know program is a collaboration between our health plans and the provider community. It helps us identify members who may need outreach, connecting them to community-based organizations to assist in their wellness plan and avoid adverse health outcomes.

Connecting members to life-sustaining resources

Screening for SDOL allows us to quickly identify a member’s status as in crisis, vulnerable, or stable, and then take appropriate action, such as:

The mission continues

AmeriHealth Caritas is a recognized, national leader in integrated health and coordinated services across the care continuum. Our innovative, community-based programs are aimed at reducing health disparities and addressing the root causes of poverty. Some examples of programs that go above and beyond clinical care include:

• Transportation: Rides to and from health care appointments are made possible through partnerships with local transportation services, such as Lyft in Washington, D.C.
• Housing stabilization: Assistance is available to help members navigate the housing system in order to secure affordable housing through federal, state, and local programs, and we can also arrange modifications to existing housing to meet members' health needs.
• Emergency food: We help members with qualifying health needs access nutritious meals through partnerships with programs such as the Metropolitan Area Neighborhood Nutrition Alliance (MANNA) in Philadelphia and Mom’s Meals nationwide.
• Education and employment: Programs such as Mission GED and Pathways to Work help members on their journey to self-sufficiency by preparing them for jobs and career opportunities.

In 2021, AmeriHealth Caritas made a major investment in Wider Circle, an innovative health organization that uses technology to create hyper-local, neighborhood-based health programs and social networks. This is one more way we are working to address social and environmental factors so people in need can better draw on their resilience to improve life outcomes.

In addition to building relationships with community partners like these, addressing the massive environment that impacts SDOL requires an infusion of resources and government approval to use Medicaid dollars in new and innovative ways. Ultimately, we’re talking about a complete change in how Medicaid is delivered, and AmeriHealth Caritas is positioned to lead the charge.

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¹Sanne Magnan, "Social Determinants of Health 101 for Health Care: Five Plus Five," NAM Perspectives, Discussion Paper, National Academy of Medicine, Washington, D.C., 2017, https://nam.edu/social-determinants-of-health-101-for-health-care-five-plus-five/.