Jeanine Davis,  RN, BAAS, CMCN

Clinical Liaison

(click to enlarge image)

Every year, the Managed Care Forum brings together members and healthcare executives from the American Association of Integrated Healthcare Delivery Systems (AAIHDS), the American Association of Managed Care Nurses (AAMCN) and the National Association of Managed Care Physicians (NAMCP).  Each forum offers educational and interesting sessions from some of the tops minds in the industry.

One interesting session from this past week’s 2017 Fall Managed Care Forum at the Mandalay Bay Resort and Casino in Las Vegas, Nevada was “Integrating Determinants of Health into Clinical Programs.”  This presentation featured an all-star cast of professionals including Deborah Keller, COO for TCS Healthcare Technologies, Edwin Choi, a Designer for Involution Studios, and Jonathan Burke, DO and Medical Director for Populytics, Inc.  This session broadened my understanding of determinants of care and social determinants of health (Yes! There is a difference).

The session focused on the implications of a single statement:  “Your health is not just your medical care.”  Although this idea is something that health care providers have known for years, the health system still focuses almost exclusively on clinical care.  Their presentation argued that we need to do more than just know this fact to achieve a more holistic view of health that measures an individual’s entire experience rather than just the transactional factors associated with our current clinical care system.

To incorporate these determinants of health into clinical programs the team presented a research-based model that categorizes all the social factors that affect quality of health into a single cohesive graphic.  This graphic itself, which was developed and presented by Edwin Choi, uses a stylized combination of ring and pie chart to display the various determinant categories and associated elements.  However, the genius of this chart isn’t just the visual impact, but also the suggested methods for data collection.  Edwin Choi, in his presentation, points out that healthcare has a lot of factors involved, but we current focused on the medical and clinical care side.

The best part is that the graphic is available to all for FREE, Click Here.

The presentation then transitioned to Deb Keller, who provided practical information to help organizations integrate the determinants of health into their care management programs.  She emphasized the importance of having a strong team that also includes the buy-in of leadership.

She also described several practical ways for organizations to address determinants One of them was a recommendation for organizations to ask themselves and their members a key question during each encounter.  Deb Keller gave two examples of these “always ask” questions: “Has this member benefitted from my actions?” and “What am I not asking that I should be?”.  Her assertion is that these “always ask” questions could and should drive the direction of an organization’s future improvement plans.  Deb Keller also provided some very useful tips and HRA sample questions regarding the steps required to launch such an initiative.

For the grand finale, Dr. Burke gave perspective from his real world clinical practice.  Dr. Burke was trained to use a whole-patient philosophy that incorporates the mind, body, and spirit.  As a result, he has fused this thinking into the care management model for the population managed by Populytics, Inc.  This model uses health coaches that work directly with members to create goals and strategies by utilizing the “Determinants of Health Model” developed by Edwin Choi as a foundation for their care model.

Dr. Burke also noted that providers must be involved in the care model.  His team is currently working with their provider network to enhance community health initiatives.  This all collects into a positive and potential paradigm shift that moves providers from focusing on diseases and episodes towards a more holistic view of the patient.

In short, this very daunting and complex topic was very illustrative and full of practical advice and useful tools. This excellent presentation moves us closer to figuring out how to move the industry towards a more value based and holistic way of thinking?”

Further information related to this and all the sessions presented at the forum is available on the AAMCN web site.