Proof of Concept to Proof of Scale: Making SDOH Benefits Matter
A look at Solera’s Partnership with the BCBS Institute
Spring is in the air as the buzz around social determinants of health grows towards a fever pitch. One quarter into 2019, two of the hottest areas for managed care organizations (MCOs) have been delivering transportation services and healthy meals as covered benefits.
The need to streamline health insurance’s complex benefits process to integrate these sorts of non-clinical supports and services (often called “supplemental benefits”) remains a key bottleneck for every group involved: MCOs (payment, performance, efficiency), consumers (eligibility, experience, access), and community based organization (CBOs) networks (data, dollars, and trust.)
This thorny rosebed of opportunity is what makes this week’s announcement from Solera Health and the BCBS Institute so intriguing. Food and rides happen to be the starting points here, too, but a closer look suggests this partnership is a different strain from the pilots popping up all over the PR wires.
We grabbed a virtual coffee with Brenda Schmidt, Solera’s CEO to learn more about how this new partnership will work. Our overarching question: What does this deal mean for this particular juncture of market adoption of SDOH innovations?
In a nutshell: This deal represents a small but important shift from proof of concept to proof of scale. It suggests the potential for a broader evolution of point solutions and grant-funded pilots for X, Y, Z condition, to a more holistic, platform oriented approach to address SDOH that is scalable to the population level, and sustainable at the community level.
Proof of Concept: Balancing Value On Three Legs of the Stool
Solera has handily checked off the proof of concept box over the last three years. Their original Diabetes Prevention Program (DPP) model (above) has grown steadily into an “extended care marketplace that connects patients, payers, and physicians with a curated network of programs and services paid for outcomes through medical claims.” The value proposition has landed and taken root across Medicare, Medicaid, and commercial markets, focused on addressing those three bottlenecks above:
- CBOs: Hundreds of local programs, partners (grocery stores, kiosks, coaches, blood banks, pharmacies, etc.), gains access to patient volume and predictable payments through a “digital ecosystem.” Solera facilitates outcomes-based payment for CBOs by “getting creative” with health plan clients on what metrics and codes they can bill for, and what data they need to collect from CBO partners to demonstrate those outcomes.
- Consumers: Health and SDOH are not one-size-fits-all, and the platform emphasizes customization of the right resource to the person (rather than to the general condition or unmet social need), while bringing a more modern approach to engagement and enrollment. “A Lyft ride may be the best option, but for someone who needs door -to-door or chair-to-chair transportation, we are networking local volunteer/grant funded transportation services.”
- MCOs: Payers need help engaging both of the above groups, which represent the “supply and demand” of delivering social supports as medical benefits. Streamlining the administrative complexities, especially around payment, is the lynchpin. According to Schmidt: “Our IP is the curated network, personalized matching into that network, and payment innovation to pay CBOs through medical claims.”
Getting to Proof of Scale
This deal is important one for SDOH innovators to understand because it has the potential to be more than a spring fling. The breadth of plan/member reach represented by the Institute, combined with the depth of Solera’s “personalization potential” in other chronic disease areas or social determinants like financial stress, loneliness, maternal health, or substance abuse disorder down the line, are what make this exciting.
In addition to the“ infrastructure → intervention” stack, the potential to loop CBOs into value-based contracts represents a fundamental turning point for SDOH innovation. The vision there, Schmidt told us, is to “create aligned incentives and a sustainable revenue model for organizations who have traditionally been grant funded.”
- Breadth: Reach & Footprint Potential: Through this partnership, 36 Blues plans will gain access to Solera’s “integrated benefits network” to match, deliver, and pay for non-medical care, based on measured outcomes. On the flip side, they gain access to a strong channel setup, the basic structure of which Schmidt was kind enough to share:
“Solera and BCBSI have a 3-year business development agreement and strategic alliance to co-develop, operationalize and implement SDOH that meets each payor’s specific strategic goals. The platform and network are national and available to all Blue plans. Solera will contract with each separately for the specific benefits they would like to offer their members.” - Depth: Personalization Potential: She also said this project is about overcoming “the unique environmental and cultural influences and barriers to successfully coordinating regional patient resources at scale.” Importantly, this will be available to all Medicare, Medicaid, and Commercially insured members in these plans.
Conclusion: A Rosy Outlook — but beware the thorns
At this juncture, calculating an ROI of SDOH for things like food or rides has become somewhat of an academic exercise. A lack of evidence is less of a barrier to social determinants than a lack of what Sachin Jain calls “Radical Common Sense.”
In 2019, social innovation is about effective impact. Delivering non-clinical benefits in a customized, streamlined, measurable, replicable, scalable, and most of all, easy to use way, for all three legs of the stool — CBOs, Consumers, and the Payer — is the next frontier for managed care to address SDOH. Solera is not alone in their ambitions.
Centene’s Social Health Bridge is a fledgling idea, but a signal of what’s to come for national level payers; for what it’s worth the insurer just bought WellCare to expand their foothold in Medicaid and MA. Another recent merger on the provider side, Commonspirit Health, announced a partnership with United Way’s national 2–1–1 program that anticipates similar needs at a national level, starting in CA.
It’s important to understand that beneath all these business announcements lies a cottage industry of efforts from the gamut of HIEs, state associations, foundations, public health departments. But intentions aren’t enough — the value for all parties needs to be real. Despite these announcements, we’re not there yet. As with any early market, it’s important to beware of where we are on the hype curve. If we could look into HCSC’s walled garden we’d be curious how those flashy PR buds from a year ago have bloomed, as a way of gauging how this one might fare.
So while we remain cautiously optimistic about this new partnership, keep giving these new partnerships the sniff test, even as they begins to blossom.
- How can plans conduct effective mass member outreach to target, educate, and enroll consumer beneficiaries about social supports?
- How will Solera fare at converting Institute member plans into paying customers over the next three years? How will these plans be able to learn from each other through the use of a common software platform?
- How might their progress help drive the broader market of MCOs (and at-risk systems) to move beyond food and transportation this year, to develop measurable, codeable, deliverable interventions for other social determinants of health as part of standard coverage policy?
