OSF Taps Socially Determined to Solve Barriers to Better Health

Companies such as 23andme and Ancestory.com are becoming more popular as people begin to consider how genetics can influence their health. But providers, including OSF HealthCare, are paying much more attention to a patient’s zip code these days.

That’s because research is showing where you live has a far greater influence than genetics on your overall health. For example, the Robert Wood Johnson Foundation has used data to tie life expectancy to zip codes. You can type in your own address here to see life expectancy in your neighborhood.

Family Doctor Trenor Williams started paying more attention to where a person lives and other social factors when he realized his mom, a social worker, talked about so many factors influencing her patient’s ability to be healthy. Then, he began working as a consultant for the former chief medical information officer for the Veterans Administration. He was asked to take a look at social risk factors that contributed to problems such as suicide among military veterans.

That initiative led to him co-found Washington-based Socially Determined, a start-up cloud-based data analytics company that helps integrate data into a platform to identify health care needs to help communities solve barriers to better health such as food insecurity, housing and transportation.

According to Williams, “40 to 60% of your health care outcomes are influenced by social risk factors. We haven’t thought about how to integrate that information into the decision-making process and how we support people, and so we saw that as a huge opportunity.”

Socially Determined looks at open source data from agencies such as the U.S. Census, Department of Labor Statistics, and the Department of Agriculture along with commercial data, such as vehicles purchased, and what’s called ‘aggregated people data by zip code’ including credit scores.

Williams says his platform uses business intelligence tools to analyze the number of people and locations of vulnerable populations.

“We look at a population of 700 moms who have gestational diabetes and hypertension, and also have economic risk and food insecurity to look at where there are opportunities to intervene around that population. So we look geospatially as well as at populations.” 

Sarah de Ramirez, MD, vice president and chief medical officer for Clinical Innovation was pleased to learn OSF Ventures, the health care system’s investment arm, decided to invest financially in Socially Determined and that OSF HealthCare will use the platform to get a fuller picture of patients served.

“[Socially Determined takes] consumer, federal, state, and local data sources and puts them along-side our clinical screening and clinical patient care data to have a whole patient view of all the patient’s needs for the pursuit of wellness,” said Dr. de Ramirez. 

Socially Determined also works with health care organizations such as OSF to design meaningful interventions. That should help collaborative efforts with community partners, according to Dr. de Ramirez.

“[This will allow us] to be proactive, good partners in a community and able to strategically impact the things that matter most to our patients,” she said. 

Socially Determined is a relatively young company but it has created a repository of insights already revealed by data from Medicaid and Medicare claims. For example, the data has identified that use of the emergency department is linked to homelessness, and social isolation is a risk factor for stroke and heart attack.

Williams says his company is also compiling profiles of the most effective solutions to meet patients’ social needs.

 “We also can look at the difference between interventions with populations in urban areas versus suburban or for OSF, where a lot of your patients are in rural communities; how might we need to look differently at intervention strategies and the risks that those patients have?” 

For example, giving patients free Lyft rides to the doctor’s office might work in a city that has a ride-sharing service but that’s not an option for a rural community such as Monmouth, Illinois. Solutions have to be scalable, sustainable and cost-effective – all big challenges. However, there is also a financial incentive to tackle the social factors impacting health because government programs are focusing reimbursement on better outcomes. Williams believes using his company’s comprehensive data will be part of the prescription for preventing disease, and improving patient outcomes and community wellness.

OSF Ventures this week announced it has joined four other organizations in raising a combined $7.5 million dollars in Series ‘A’ funding to advance efforts of Socially Determined as the company strives to become the predominant data and analytics leader for health care systems looking to reduce the cost of care while improving patient outcomes.

Learn more about how OSF Innovation is transforming health care through community-based solutions.