Population health management and social determinants of health

The global population health management (PHM) market, including services and software, is projected to grow to $91.4 billion in 2026 from $21.4 billion in 2018, a 19.9% compounded annual growth rate, according to Fortune Business Insights. Market growth reflects the industry’s shift to value-based from fee-for-service payment models, and the resulting expansion of integrated care delivery, new tools and resources for engaging with patients, and greater data transparency and functionality.

The focus of PHM has largely been consistent, targeting improved clinical care coordination and management of complex and chronic conditions for better health outcomes and increased revenue. Healthcare providers have demonstrated success in implementing PHM strategies, but continue to be challenged to think beyond the clinical setting and respond to the social and environmental factors affecting patients. Termed the social determinants of health (SDOH), these factors will continue to push providers to engage with new and diverse partners and consider nonclinical investments as part of their financial strategy.

Healthy People 2030 defines SDOH as “the conditions in the environments in which people are born, live, learn, work, play, worship and age that affect a wide range of health, functioning and quality-of-life outcomes and risks.” These conditions are at the forefront of new PHM initiatives as providers acknowledge the nonclinical factors, such as education, poverty and housing, that predict as much as 50% of an individual’s health. Evaluating and responding to the SDOH is central to effectively and profitably managing patient health outcomes and is perhaps the single-largest opportunity for demonstrating success in a value-based care environment.

The role of SDOH in healthcare and PHM

In 2019, the Centers for Medicare & Medicaid Services (CMS) approved new waivers to address SDOH needs as part of the Medicaid benefit package. In a February 2020 research article published by Health Affairs, researchers identified 57 health systems, encompassing 917 hospitals, that implemented new programs involving financial investment in SDOH. Housing-related programs were the top investment focus area for health systems, followed by employment, food insecurity, education, social and community context, and transportation.