Data gaps could amplify difficulties for health plans

In an interview with Health Payer Intelligence, Caroline Pearson, Nexus Fellow and Senior VP of Health Care Strategy at NORC at the University of Chicago, emphasized that the industry’s understanding of effective payment models and strategies for social determinants of health management is “riddled with unknowns.” Her remarks appear in an article: The State of Payer, CBO Social Determinants of Health Contracting.

It is natural, for example, for organizations like large healthcare providers and payers to turn to smaller community-based partners for on-the-ground insight and service delivery. However, according to Pearson, it can be problematic with smaller partners who lack the infrastructure to cover a large population, or are unable to provide the kind of data needed for decision-making.

How can you know if a community-based organization is going to be a good partner for you? Pearson says one key indicator may be their ability to gather and exchange this data.

“The data requirements to deliver supplemental benefits to a health plan population are pretty high: you need some way to identify those members, you need to be able to receive the referrals from the health plan, and then, increasingly, those health plans really want a feedback loop where you can give them information about the result,” Pearson said.

But Pearson explains that even if an organization lacks this ability it’s still possible to work with them –if you can involve a vendor who provides a platform to bridge the gap.

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