Looking beyond medical claims data to understand the social determinants of health


Ralph Perfetto is the Chief Analytics Officer of Eliza Corporation.

Ralph Perfetto, Chief Analytics Officer at Eliza Corporation, joins State of Reform’s Executive Outlook to talk about how our health systems rely too much on medical claims data to understand the health habits of their population. He proposes that it is time for leaders to be more innovative in their uses of data when addressing the social determinants of health.

The healthcare industry has embraced ‘Big Data’ as a solution to the problem of identifying populations most likely to utilize healthcare services. Not surprisingly, healthcare organizations gravitate towards the most familiar source of data generally available – medical claims data. Although we can effectively use utilization patterns to predict who is more likely to have future health problems, how can past utilization data insights inform us about the people who aren’t utilizing healthcare services?

Most often, healthcare organizations simply presume that the absence of medical claims is the best indication of whether a person is happy and healthy. Put differently, if there is no indication of health problems in the medical claims, then they must not exist? For some, this perspective may very well be true. For many others, however, this line of thinking can be dangerous both to patients and ultimately to the financial bottom line.

Although science and technology has made it possible to glean information about the health and wellbeing of patients in novel ways, our choices regarding whether or not to ignore certain types of information is often keeping us in the dark. Healthcare providers have become very good at treating disease and extending life, but some seem less invested in understanding the quality of peoples’ lives and how this effects health outcomes. This is even more pronounced in disadvantaged populations where health inequities can be enormous. For many disadvantaged people, social and cultural conditions in their environments effect a wide range of health functioning and quality of life outcomes.

It isn’t just me who thinks this is true. The US government’s Healthy People 2020 campaign is the newest iteration in a long list of programs undertaken with the explicit goal of “Creating social and physical environments that promote good health for all.” Assessing Social Determinants of Health (SDOH) is the foundation of this program. In fact, the government is very interested in these topics and assesses them in a wide variety of surveys.

Speaking at a recent healthcare benefits conference, Eliza’s co-founder and Board Chairperson Alexandra Drane mentioned the phrase ‘life sucks disease’ to emphasize how daily stressors and life context can often manifest themselves into real physical and emotional health problems.

In a recent Eliza program exploring social determinants of health in the members of a managed healthcare plan, I found that;

• 40% of respondents reported having some difficulty getting to the doctor’s office
• 35% of respondents were concerned about the cost of the tests
• People who report concerns about life necessities were 5x more likely to report poor health than very good health
• People with self-reported ‘life problems’ also reported that their health negatively impacts their work functioning by nearly 2.5x more likely to than those without life problems
• Similarly, people reporting concern for life necessities were 8x more likely to report high emotional stress.

Although these data are compelling, we’ve passed the point where more evidence is needed to prove the relationship between social determinants and health outcomes and are now at the point where early identification, screening and effective interventions and services are needed.

Unfortunately, there isn’t a diagnosis code for ‘life sucks disease’ and often socio-economic barriers fall outside the boundaries of services for many health plans, providers or other healthcare professionals. Absent from claims data is material knowledge surrounding a person’s life situation. After all, how can we truly deliver effective care when we ignore life factors impacting people that can potentially undermine our noble intentions?

It’s time we started to direct more effort and resources towards the collection and analysis of new data resources related to a person’s life situation. Our serious lack of contextual data hinders our ability to meet the health needs of the 21st century. Healthcare organizations must address issues of social inequities, diagnose problems and remove barriers that negatively impact health status and quality of life.

A good starting point to help assess and address SDOH is to deploy a strategy that Eliza has labeled the ‘four Cs’ – Communicate, Collect, Compare and Connect. Since SDOH are not easily accessed within a clinical or claims data system, it is imperative that health plans open a dialog and engagement with their members directly. Open communication is vital! Conversations can be simple and inexpensive (using automated outreach technologies, such as telephonic and digital modalities) to more intensive live agent or in-person interviews. Regardless of the format, there should be a concerted effort to collect data about life problems and SDOH using standardized and validated survey tools. Perhaps implement a vulnerability assessment and/or analyze other relevant census, consumer or non-traditional sources of information about a person’s life context. Many survey tools can help identify life problems that negatively impact health, and are difficult to ascertain without asking people directly. Equally important is the need to compare survey results to known benchmarks and norms so that each person’s health burden is measured and compared using a common ruler. After all, it would not be advised to compare the health of a low-income, 75 year old male suffering from depression due to chronic pain to a middle-aged female suffering from job stress and burdens associated with care-giving. Finally, the ability to connect people to meaningful programs that help people overcome barriers and obstacles, such as community services, coaching and job training and placement, childcare, and transportation services are necessary to achieve any meaningful results.

While healthcare organizations really do care about social determinants of health, there still seems to be an almost universal fear of collecting too much information about a person’s life context in the health industry. I like to refer to this phenomenon as data fear. What is that? It’s fear of knowing something about your patient population that you cannot or will not act on. At least not in the immediate sense. Imagine learning something about a segment of your population that will certainly influence health outcomes and future healthcare expenditures. Yet, you don’t have the ability (or resources) to change the situation. We have to overcome this data fear and recognize that we will not solve all SDOH problems immediately. However, more data will at least help inform and prioritize new programs and services that help people overcome life’s obstacles. In the end, these programs and services will help minimize barriers to care to provide long term ROI for healthcare organizations by creating a partnership with individuals that improves health and brand loyalty.

Let’s embrace the whole person and not merely the medical record. The Social Determinants of Health are the key!

About the Author:

Dr. Ralph Perfetto brings over 20 years of experience creating innovative solutions for measuring the effectiveness of care, health plan performance, and patient outcomes. In his role as Chief Analytics Officer, Ralph is responsible for the strategic development and operationalization of Eliza’s consumer health data assets – including our proprietary Behavioral Intelligence asset – to ensure optimal engagement and impact. He also oversees the delivery of professional services in the areas of Strategic Analytics and Interaction Design.

Ralph has extensive healthcare-specific knowledge in managed care, risk analysis, and product adoption, based on his previous leadership role at PatientInsights Division of Optum, where he served as Vice President of Product Development and Population Health. Prior, Ralph co-founded QualityMetric, a health survey company acquired by Optum, and was a co-founder and Chief Operating Officer of Response Technologies, Inc., a leading provider of software and hardware solutions used to measure health risks, and provide immediate feedback reports to patients and employees engaged in wellness initiatives.

Ralph helped to commercialize the world’s most widely used patient-based health outcomes measurement tools (SF-12/36 v2®). He also co-developed patented data-driven, psychometrically valid, computer-adaptive health outcome tools used for managing disease and measuring patients’ physical and emotional well-being during various treatment options.

Ralph serves as an Adjunct Professor of Marketing for Worcester Polytechnic Institute and has published work in several peer-reviewed marketing journals. He holds a Bachelor of Science degree in Mechanical Engineering, a Masters of Business Administration, and a PhD in Business Administration, all from the University of Rhode Island.

Ralph can be reached at rperfetto@elizacorp.com


About Eliza Corporation

Eliza Corporation is a pioneer in technology-enabled healthcare communication—engages with individuals and helps close gaps in care with behavior-driven analytics and multichannel communications that make interventions efficient and effective.

After almost 20 years of communicating with healthcare consumers, we’ve developed one of the world’s largest data assets of their behaviors and motivations. We use this data—along with proprietary analytics and predictive models—to determine the individuals most likely to engage with our interventions and to achieve the desired result. We then leverage our experience with behavioral science and expert communication design to develop an engagement campaign that delivers targeted messaging via a multichannel engine. For more information, visit elizacorp.com or contact 1.800.701.7864. Join Eliza on LinkedIn and Twitter.