More Thinking and Insights

SDoH and Stars

March 31, 2021  |  Guidance


Yogin Shroff, Senior Partner and Chief Operating Officer

As CMS Stars continues to grow in both scale and difficulty, so too must health plans and systems display principled agility to keep up with the many growing demands.

There is a considerate shift occurring within the CMS Stars structure which enlists an everlasting impact on both members and healthcare establishments. As member experience and member satisfaction take on prominent roles in obtaining desired Star rating goals, healthcare institutions must pivot towards addressing social determinants of health as opposed to solely treating individual illnesses. This intervention comes in many forms, but in totality, requires strategic, laser-focused, and analytical thought leadership.

Addressing Social Determinants of Health within Stars

SDoH transformation revolves around identifying and executing innovative, creative solutions to meet members where they are. Healthcare organizations should strive to develop impactful member touchpoints, augmented by a robust provider engagement program. Thus, three areas can be utilized immediately for maximum positive impact across both population health and therefore, CMS Stars.

First, leverage Federally Qualified Health Centers (FQHCs) as strong partnership candidates for healthcare organizations seeking positive population health outcomes. The FQHC business model is structured around providing healthcare access to underserved populations. Second, aim to change provider behaviors to encourage greater care coordination. For instance, advocating the usage of SDoH-specific screening questions and z-codes as part of the health risk assessment is an important part of understanding the population's needs for customized solutions. Lastly, incorporate dedicated member outreach teams to engage with members to educate them on their healthcare needs and mitigate their barriers to care to successfully complete necessary medical activities.

Mobilizing Stars in an organization, specifically one consisting of great population health concerns can be difficult and overwhelming. But at its core, healthcare leaders must understand that the path to mitigating social barriers is largely dependent on one's zip code, not necessarily one's genetic code.

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