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How Unmet Social Needs Shape Healthcare and Consumer Health

06/03/2020

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An article “Understanding the impact of unmet social needs on consumer
health and healthcare” by Erica Coe, Jenny Cordina, Danielle Feffer, and
Seema Parmar, dissected two surveys by Mckinsey conducted on US
residents aged 18 – 84 in 2019. “Consumer Social Determinants of Healthy”
examined 2,010 low-income respondents who are uninsured, have private
insurance, Medicaid and Medicare. The US has two major social healthcare
programs, Medicaid and Medicare. Some people qualify for both Medicaid
and Medicare. “Consumer Health Insights” surveyed 4,958 respondents who
participated in making health insurance decisions regardless of whether they
were uninsured or had coverage.

Medicaid is a federal-state assistance program where local governments set
eligibility criteria and coverage according to federal guidelines. Recipients are
no- to low- income families and individuals of all ages where patients pay very
little to nothing for healthcare services. Notwithstanding discrepancies in each
state, mandatory benefits include coverage for care and services at hospitals,
skilled nursing facilities, federally qualified medical centers, and certified
pediatrics doctors and related medical providers.

Medicare is a federal insurance program that pays for medical services from
trust funds for consumers who have previously paid for these services. It is
primarily offered to individuals aged 65, below 65 with certain disabilities, and
to all patients with End Stage Renal Disease or Lou Gehrig’s disease (ALS).
As payments vary according to coverage, patients pay for some of the
hospital and related costs themselves, and non-hospital coverage will require
small monthly premiums.

These differences between patients and insurance categories have some
bearing on the findings. Of the 10 categories of social needs examined in both
surveys which included income, family size, education, and employment, the
article only focused on evaluating how well six social needs or basic
resources were met based on the quality and access to safe housing,
transportation, community safety, food security, community and personal
safety, and social support to see how each variable impinges on respondents’
overall health and wellbeing.

UNMET SOCIAL NEEDS AFFECTS ALL CONSUMERS
“Consumer Health Insights” revealed that while 52% of respondents had no
unmet needs, of the 48% who had one or more unmet social needs, Medicare
consumers reported higher levels of unmet needs than other insured
consumers, primarily due to their socioeconomic circumstances, while
Medicare had the least proportion of unmet social needs. Nevertheless, 24%
had two or more unmet needs, though certain health problems leads to
reporting more unmet needs as people with good mental health tend to be
less dissatisfied than those with poor mental health. Service providers have to
examine patients’ problems in the community context to more closely
determine deficiencies.

CONSUMERS WITH MORE UNMET NEEDS RELY MORE ON
HEALTHCARE SERVICES
Individual social risk scores are used to quantify and predict the link between
unmet social needs and health, whereby higher scores indicate both greater
unmet social needs, and the potential degree to which their health is affected
in the long run. This also led to some broad conclusions given the divergent
demographic targets of each type of coverage. Consumers who use in-patient
and emergency room (ER) healthcare services tend to report more unmet
social needs than those who rarely use healthcare services. Nevertheless,
individual needs and utilization rates vary the way transportation is more
important to an ailing Medicare consumer than a healthy Medicaid consumer.

Overall, Medicare consumers listed that their greatest priorities are safe
housing and transportation, while those who have poor health value
community safety as the key determinant of their rates of in-patient and ER
utilization. Medicaid respondents and those with unstable incomes causing
them to shift in and out of the system illustrated that food and personal safety
were key markers of good health. Medicaid consumers in poor health showed
that the level of community safety is correlated with their in-patient stays but
not ER utilization.

As empirical findings match intuitive hypotheses, it is useful to see how each
social need is prioritized and used to deliver tailored solutions to various
populations and locales. As Medicare and Medicaid service providers have
clear target populations, they can improve key areas of unmet social needs
where possible to reduce the burden on healthcare services. Local service
providers will also need to increase their capacity in locations with structural
deficiencies that naturally raises in-patient and ER utilization.

HIGH SOCIAL RISK OFTEN RESULTS IN LIMITED ACCESS & HIGH
DISSATISFACTION WITH HEALTHCARE
Among respondents with public coverage with high social risk scores, 37%
reported that they did not receive all the healthcare services they need.
Among consumers with at least one healthcare encounter over a year, 52% of
those with high social risk scores were satisfied with their experience
compared to 81% of those with lower social risk scores. Even lower social risk
score consumers did not receive all the care needed as 24% were not
sufficiently served and 64% of those who had at least one annual healthcare
encounter were satisfied. Yet much of the dissatisfaction due to receiving
insufficient healthcare services is not due to social factors, but factors such as
health literacy, affordability, expectations, and access illustrating that much as
to be done to make healthcare more readily available to those who need it
most.

HIGH SOCIAL RISK CONSUMERS PREFER ALTERNATIVE HEALTH
SERVICES
Rather than visiting designated healthcare providers, high social risk
consumers with some form of government insurance and support prefer to
use ER or alternative treatment such as pharmacies and telemedicine. In fact,
81% prefer to be supported from a wide range of people: 58% want a primary
care provider, 27% from friends and family, and 21% from therapists.
Consumers with limited health risks also prefer primary care providers, family
and friends but only 2% want support from a therapist. Ironically, the
availability of smartphones which elicited high interest as it provides digital
health solutions had little uptake. Neither do extending hours at drop-in clinics
generate significantly more visits as 30% of at risk consumers never used
these channels.

This gap between initial interest, uptake and actual usage reveals
mismatched requirements and offered solutions. This outcome points to a
need for greater engagement of all parties to create more specific solutions
for each consumer, and stock preferred alternative care sites with sufficient
resources to support some social deficiencies. But more importantly, it means
that more solutions have to be co-designed with consumers to give them what
they need delivered to their expectations.

For example each consumer’s care plan strategy is discussed and the next
steps set forth according to their social context which could include
partnerships and targeted interventions from local communities to provide
missing social services as needed. Paying consumers have to be more proactive
in informing service providers of areas they want more support to make
better future investments that yield effective solutions with higher engagement
of all parties. Success in each location is specific, so an effective healthcare
model has to be inherently flexible enough to be tailored according the
population needs everywhere.