Dr. Zachary Pruitt examines how managed care organizations address social determinants of health

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Dr. Zachary Pruitt, assistant professor of Health Policy and Management at the USF College of Public Health, is the lead author on a new study showing how managed care organizations can help address the social determinants of health.

Zachary Pruitt, MHA, PhD

The research, “A Managed Care Organization’s Call Center-Based Social Support Role,” released by WellCare Health Plans, Inc. and the University of South Florida is published in The American Journal of Accountable Care (AJAC).

It examines how WellCare CommUnity Liaisons, a new social-support person role, can effectively use their own personal experiences to provide social support to study participants (callers) experiencing a broad array of stressful life circumstances such as homelessness, food insecurity and financial difficulty.

According to the study, previous research shows stress is related to increased morbidity and mortality. Additionally, a majority of physicians acknowledge that unmet social needs contribute to poor health outcomes; yet most report they lack the time to address these needs during clinical appointments and look for social service coordination to be funded by payers, such as managed care organizations (MCOs).

Through the study, researchers examined WellCare’s Community Assistance Line, a toll-free, nationwide phone line open to WellCare members and the general public that helps refer callers to a network of community-based public assistance programs. The line is supported by CommUnity Liaisons, who use their own personal experiences with the social service system, and a database containing more than 160,000 community resources to identify service gaps and manage referrals with local social service networks in 10 languages.

Key Findings: Social Support with Community Surround Sound

To understand the impact of staffing the call center with CommUnity Liaisons, 13 in-depth interviews were conducted around informational support, including advice and referrals callers could use to address their problems, as well as the underlying reason for a participant’s call. In addition, the delivery of tailored information based on the Liaison’s personal life experiences and ability to provide emotional and empathetic support was captured.

During the year-long study, nearly 11,800 individuals contacted the assistance line resulting in more than 34,000 referrals to social supports. The most requested area of social assistance was patient and family support (25 percent), including medical expenses, elderly care and daycare assistance. Transportation to and from doctor visits (after benefits are exhausted) was the second most requested service (20 percent) followed closely by housing needs (18 percent). Personal goods such as hygiene products and clothing along with food was also a frequent need at 15 and 13 percent, respectively.

Liaisons shared that in all instances an adverse circumstance triggered a caller to contact the assistance line. And while Liaisons shared their main goal was to provide informational support to callers, more than 50 percent of Liaisons stated they provided emotional support conveyed through empathy, love, trust and caring. In fact, several respondents acknowledged callers’ emotional needs must be met before providing informational support.

The research cites several instances where the Liaisons’ life experiences enabled empathetic understanding and delivery of tailored information to a disabled person, a caller in need of transportation services and social support due to a similar disease-specific experience.

“What was striking and what we did not know going into the study was the caller’s underlying motive,” said Pruitt. “In almost every instance, calls were triggered by a major adverse event or social crisis in the person’s life, be it eviction, spousal abuse, inability to pay medical bills, the culmination of social isolation or lack of food. This is extremely important when thinking about how CommUnity Liaisons are unique in the role of a community health worker.”

“The results of this study clearly point to the power of the peer network in quickly developing a bond with callers and helping them navigate the network of social resources,” said Pamme Lyons Taylor, vice president, WellCare’s Center for CommUnity Impact. “By developing the CommUnity Liaison network, WellCare is creating an incredibly inclusive and diversified environment that has the power to help shape how we think about solving complex issues around social determinants of health and getting our members the right care when they need it most.”

Study Methodology

The study used an explanatory case-study protocol which consisted of multiple evidentiary sources including in-depth interviews, training documents and program data and enabled analysis of the application of the community liaison role to social support theory within a logic model framework.

 

Media Contact:

Natalie D. Preston, USF College of Public Health

(813) 974-7714, or npreston@health.usf.edu

 

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