Dr Lewis Sandy on Payment Reform and Social Determinants of Health

The healthcare industry is undergoing payment reform, which includes important initiatives like addressing social determinants of health, but may not be keeping the patient perspective central as these changes are made, Lewis Sandy, MD, senior vice president of Clinical Advancement at UnitedHealth Group, said at the AcademyHealth National Health Policy Conference.

Transcript

How much do patients understand about the payment reform that is going on?

The issue of how patients and consumers are being brought along in this transformation of medical care, payment, and delivery, is a really important issue. Most of the action has been driven between purchaser, payers, and care delivery systems, and patients have really been left behind. That's one of the areas that I think is most important and we need to address further: increase the patient voice and bring the patient along, and have their perspective as central to the discussion.

How are new payment models better able to address social determinants of health?

Payment models are beginning to address social determinants of health and this is being driven by the data. As these new payment models and quality measurements unfold, delivery systems are recognizing there are certain issues that they can work through and address through medical care, but there are many others that require cooperation and engagement of many other parts of society.

These social determinants of health, such as housing, education, fragmented families, issues of substance abuse, mental health, all of these are critical issues and we are beginning to see new models emerge that take a much broader, bio-psychosocial sort of view of how to drive improvement.

How can the healthcare industry handle quality measure fatigue?

The issue of quality measure fatigue is a real one. We have gone from not doing enough measurement to having too many measure, people say. And I'm really optimistic that we are really starting to address the issue of alignment of measures, the development of core measure sets—there are a number of initiatives under way to do that—and to identify the high-priority gaps in measures so that we can focus in those areas as well.