Aspiring to health and wellness rather than turning to sickness and healthcare is beneficial in at least two ways—avoiding both the misery and the expense of disease. A Journal of the American Medical Association statistical analysis published last month, entitled “Social Determinants of Health and Geographic Variation in Medicare per Beneficiary Spending,” addressed this thesis by comparing the Social Determinants of Health (SDoH) with the cost per Medicare fee-for-service enrollee within 3,038 counties. About 100 counties’ populations were too small or did not have data and therefore were excluded.
The important and somewhat simplified bottom line: SDoH were associated with a 37.7% of variation in the amount of money Medicare spends on fee-for-service patients. Namely, Medicare patients living in the bottom-quintile counties for SDoH cost the government about a third more.
SDoH is a neutral, all-encompassing term, now commonly referring to the metrics that measure health and well-being. But SDoH is only the first step to addressing 80% of preventable illnesses. Implementing effective, long-term, cost-effective, and equitable “treatments” is the perfect complement, thus far without a title. Together, the need for a term describing factors that improve health becomes evident.
To this end, David Johnson, CEO of 4sight Health, recently coined the term “Healthy Multipliers” to motivate well intentioned caregivers—stop admiring the SDoH and start employing effective programs to achieve long-term improvement. “Healthy Multipliers” recognizes both the causes and solutions that can change the course of health and wellness for individuals, organizations, communities, and entire states.
Thus, “Healthy Multipliers” implies action after starting with SDoH. Addressing the rising medical costs of healthcare while also ameliorating the misery of living in one-fifth of the most stressed counties in America is a noble pursuit that has just been given academic validation in the JAMA article.
Using the statistical method of regression analysis, this JAMA paper also examined clinical risk, namely the gravity of illness in a particular county and the corresponding supply of medical resources. Clearly, counties with large numbers of patients with chronic needs—e.g., diabetes, high blood pressure, aging population—would utilize more healthcare, adding to the cost. An excess or oversupply of healthcare resources would also add to the cost because overuse often occurs. Thus, the study controlled for these factors.
The paper’s conclusion was summarized as follows: “With these findings, the researchers suggest that policies addressing SDoH for disadvantaged patients in certain regions could have the potential to contain healthcare spending and improve the value of healthcare. They [the authors] also noted that patient SDoH may need to be accounted for in publicly reported physician performance, as well as in value-based purchasing incentive programs for health care professionals.”
