As COVID-19's opening salvo on the healthcare system gradually gives way to long-term mitigation efforts, much of the public health focus is shifting away from the four walls of the hospital. Now, community-support services have found themselves shouldering a heavy burden of social isolation and nonessential business closures that, without proper support, could lead to new social determinant of health (SDOH) challenges among populations already struggling to access care and other services.
"What COVID-19 put a big magnifying glass on is our lack of public health infrastructure," Taylor Justice, cofounder and president of startup SDOH technology platform Unite Us, said during a HIMSS20 digital session. "I think cities and states, once they started to transition away from just a pure clinical response, started to realize with the increased unemployment numbers there's this unprecedented stress about to hit their human and social service systems."
Justice and Manik Bhat, CEO of fellow SDOH management platform Healthify, said that the demand for community-support services within the U.S. was already outstripping what was available, especially within rural settings. Both companies had spent the past few years connecting those in need with health resources by driving connections between community leaders, public health programs and other relevant services.
"And then [we] saw quarantine begin, and what happened then is we saw a lot of nonessential businesses close, and we saw a huge spike in unemployment claims. And that spike introduced a huge increase in demand for food and child care," Bhat said during the session. "Now, as quarantine is ending, we're seeing decreased childcare demands, we're seeing increased shelter demands with evictions on the rise – a lot of the eviction restrictions are being relieved – and we're seeing the food demand remain elevated."
To illustrate this point, Bhat noted that roughly 11% of U.S. households had some degree of food insecurity per quarter prior to COVID-19, but that those rates are now closer to 30% or higher. And while food-related referrals and interventions comprised about 16% of Healthify's total, that rate spiked to 36% in early April.
Bhat said that, while his company is expecting these high-demand conditions to remain for at least the next handful of months, the silver lining is that local government and other stakeholders are upending their usual practices. Solutions that will remain effective beyond the short term have become the priority, and many are looking toward new avenues for those answers.
"This pushes all of us and communities to think more deeply around what [do] new delivery models look like in this landscape," he said. "[For instance, h]ow do you think through food delivery in a more robust way, where you don't have to deliver food in person, but you could through a ride-sharing delivery capacity?"
Bhat went on to say that Healthify is helping many community partners with financial-planning services that can help keep individuals afloat for longer, and is sharing its aggregated data repository with charitable foundations and other groups to help them better understand which interventions will yield the greatest outcomes for their investment.
Justice, meanwhile, noted that Unite Us will be aiming to double its nearly 200-person team by the end of the year as local organizations scramble to address their long overdue social service shortcomings.
"City governments and state governments are looking for solutions, looking for answers, and historically their knee-jerk reaction during COVID-19 hasn't been human and social services," he said. "But I think we've been pretty successful at having their ear, giving them a game plan of how we can implement our solutions, and that we've done this before. This isn't a brand-new concept that we're bringing to them and saying 'hey, we think we can execute.' We're saying 'no, we know we can execute. Here are the KPIs, here's when we are going live.'"
By and large, both of the executives said that they expect a redistribution of public-healthcare spending in the coming years in favor of social-services infrastructures. The pandemic is highlighting the extent to which the current system is falling short on social needs, they said, and the public needs to have the appropriate infrastructure in place if it wants to avoid similar outcomes during a potential second wave of COVID-19.
"With these new innovative models that are happening in the service-delivery landscape, we think there's going to be a push from a policy standpoint to drive ... healthcare to address SDOH as a component of their delivery, and have the dollars in healthcare support the buildout of community-health infrastructure and the support of reimbursement for social services and capacity building," Bhat said. "Policy trends will push us in a landscape where not only will Medicare and Medicaid pay for these services more robustly, but ultimately it will be a core component of how we think about value-based care down the road. We see that in a trajectory of two, three, four, five years. That really excites us."