Addressing Social Determinants of Health with Companion Care

Along with health conditions that typically accompany aging, many older adults also suffer from loneliness, isolation, and other social determinants of health (SDOH) issues. SDOH—including behavioral, environmental, financial, and other factors—are a key reason for increased healthcare utilization and account for 80% of “modifiable contributors to healthy outcomes.”

As shown in figure 1, SDOH are generally divided into five domains that impact a person’s health across their lifetime.

Older adults are particularly susceptible to suffering from issues related to SDOH. More than half of older adults report at least one unmet social need, and one in four older adults report two or more unmet needs. Addressing SDOH can improve the health of older patients while decreasing the total cost of care by reducing expensive utilization related to potentially preventable deterioration in health.

A new approach centered on companionship, aligned with CMS’s effort to address SDOH in its new care models, is poised to support beneficiaries in their daily lives while helping providers lower the cost of care.

Medicare and SDOH

In an effort to address health equity and SDOH in a value-based environment, Medicare has redesigned and renamed its Global and Professional Direct Contracting (GPDC) Model as the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) model. The new model uses quality measures to determine earned savings and requires health equity plan development, data gathering, and increased benchmark adjustments for ACOs that care for higher populations of underserved beneficiaries.

To succeed under the ACO REACH model, healthcare providers need to find new ways to support Medicare beneficiaries struggling with loneliness, isolation, and other SDOH factors that may impact their health. Connecting Medicare beneficiaries with the social support they need via vendors that provide companion care services is a new approach to addressing SDOH and health equity that is easily scalable.

How Does Companion Care Work?

Companion care seeks to address SDOH and increase support for older adults to improve their health and quality of life. Companion care professionals are not healthcare providers. They are vetted, background-screened individuals who are matched with at-risk beneficiaries for regular visits, and they often become trusted friends to the older adults with whom they work. As shown in figure 2, these nonclinical caregivers can assist beneficiaries with numerous daily living activities directly related to SDOH.

In addition to assisting with daily living activities, companion caregivers can be trained to address healthcare objectives identified by the beneficiary’s primary care provider (e.g., annual wellness visit and care-gap reminders, virtual care technology assistance, fall-risk assessments), putting them in a position to make a positive difference in the beneficiary’s health—and help providers better control costs.

Scaling the Companion Care Workforce

Provider organizations participating in ACO REACH and other value-based care models will deploy care management nurses and care coordinators to engage patients and identify their social needs. They may choose to extend the care management team through the use of companion care services for high-risk and rising-risk patients. A companion-on-demand model provides locally vetted and trained caregivers to work with the ACO’s assigned Medicare beneficiaries and address SDOH as well as assist the ACO with achieving the health priorities for their managed patient population. Platforms that enable companion care, support Medicare beneficiaries, and can interface with the care team can help close the care loop to ensure patients receive high-quality care without accessing high-cost care settings unnecessarily.

ACO REACH participants should be prepared to provide at least 8 to 15 part-time in-home caregivers per 1,000 or more attributed beneficiaries to adequately mitigate the SDOH driving 80% of their ER visits and missed screenings. ^[1]

How Are You Planning to Address SDOH?

If you have questions about how to prepare for implementing the ACO REACH model, including how to develop the health equity plan or address the many related decisions that must be made before the 2023 performance year, ECG can help. There are also new innovative organizations, such as Papa, that can help implement a scalable app for ACO REACH participants seeking to address their beneficiaries’ SDOH. Connecting Medicare beneficiaries with the social support they need will be an essential driver of success under the ACO REACH model.

Published June 29, 2022