Joe Fifer: The courage to reframe healthcare to encompass ‘health’ 

Whether you’ve worked in this field for a day or a decade, when someone asks you what business you’re in, the answer is easy: Healthcare. And your meaning is clear. Imagine if you had answered, “health,” instead. Suddenly, that word raises more questions than it answers. Does the health business refer to fitness or nutrition, perhaps? Or some other type of wellness program?  

That simple reframe captures the reality that health is much more than just healthcare. As you may know, 60% of a person’s health status reflects the impact of social determinants of health (SDoH), defined as the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life. Another 20% of health status is attributable to genetics. Only 20% of health status is related directly to healthcare. As the implications of this health equation have reverberated throughout healthcare circles in recent years, the drumbeat about the need to address SDoH more systematically has grown louder. 

But — brace yourself — SDoH is not the right focus! The focus should be on a concept that is not nearly as well known: Cost effectiveness of health (CEoH). Simply put, CEoH is the intersection of lower costs and better outcomes. Achieving it involves minimizing costs associated with delivering optimal health outcomes and identifying spending that is appropriate to realize such outcomes. While SDoH is a crucial element in achieving CEoH, it is still only a contributing factor. And unmet SDoH needs are seemingly endless. If you dwell on SDoH rather than the end result — i.e., reducing the total cost of care on a per-member-per-month basis — then you may wind up channeling resources to initiatives that, though well-intentioned, do not move the needle on achieving CEoH goals.  

A subset of SDoH known as health-related social needs (HRSN) is helpful in this regard. HRSN refers to social and economic needs that affect people’s ability to maintain their health and well-being. Examples include housing instability, food insecurity, employment, personal safety, lack of transportation and affordable utilities. HRSN is a present- and future-focused concept, in contrast to SDoH, which include factors that may have affected people’s health going back to birth and even before they were born.  

It takes courage to reimagine what you do and to expand your focus from healthcare to health, specifically to CEoH. But I believe that healthcare finance professionals are up to this reframing challenge. The deep-pocketed tech giants that are investing in healthcare — and health — certainly are. And the market is changing rapidly.  

As healthcare transformation expert Zeev Neuwirth, MD, has said, there’s nothing futuristic about this. The future is already here.