Across all reimbursement models, the identification and management of high-risk patients is central to improving quality and cost outcomes. Most physicians believe addressing patient social needs is important as dealing with medical conditions. However only 20% of U.S. doctors are equipped to address patient social needs.
Healthcare providers need access to “patient-level” data on social determinants of health in order to ensure improved population health measures in a value base driven healthcare payment system.
SES-CONNECTS is a “measurement based” social determinants screening platform – that performs a risk stratification process to tier individual patients and assign a case complexity quadrant with appropriate care coordination level. The platform generates social determinant data which can be integrated into case management or electronic health record (EHR) systems providing “real-time” actionable patient information to support population health activities.