Lili Brillstein Discusses Incorporating Social Determinants of Health Into Value-Based Care

Unlike in fee-for-service, we have an amazing opportunity to begin to understand and build in factors that will keep patients healthy and give them the best outcomes possible, said Lili Brillstein, CEO of Brillstein Collaborative Consulting, and former Director for Episodes of Care at Horizon Blue Cross Blue Shield of New Jersey.

Transcript:

Are payers and providers getting a better handle on concepts like social determinants of health and more holistic care for patients?

Absolutely, yes. I think the value-based models create a really profound opportunity for us to begin to think about healthcare in managed care in a completely new way and in a way that brings in social determinants of health and also brings in non-traditionally covered services. For example, in fee-for-service, generally an Uber, a car service won't be covered to have a member transferred from their home to a doctor to get to an appointment. It's an incremental cost of care. It's not a covered benefit. The answer is generally no. As we move into value-based care, and we focus on outcomes, now we think about what are those services or social determinants, what things actually have an impact on the patient's outcome. Certainly as we think about getting a patient to the doctor that has a very significant impact on their outcome. Now, using this very simple example, Uber or Lyft, or some other car service, for example, could very well become part of the healthcare continuum, part of these value-based models. In the same way, we've started now to see food programs and housing programs being incorporated into models and being paid for by health plans. Again, not traditionally covered services. But now there's willingness to really bring them in and pay for them because there's understanding of the importance of having clean and safe housing on one's health or transporting somebody to the doctor or making sure they have nutritious food. That gets me really excited. I think, unlike in fee-for-service, we really have an amazing opportunity with these models to begin to understand and build in those things that will really keep patients healthy and if they're not already healthy, give them the best experience and best outcomes possible.