Blues Institute, Solera Health launch ‘disruptive’ SDOH program

The Blue Cross Blue Shield Institute is forming a “disruptive business alliance” with Solera Health, an integrated benefits network company, to determine how best to act upon social determinants of health.

“Health outcomes we’ve long known that have been affected up to 80 percent by SDOH,” says Brenda Schmidt, CEO of Solera , which helps health plans leverage a network of community-based and digital health solutions. “Prior to (value-based purchasing), the system was not set up to encourage health systems and clinicians to look comprehensively at a patient’s situated context—their socio-cultural, economic and environmental issues that lay beyond the disease state. Now with VBP, we begin to see systemic recognition to address the SDOH.”

The Blue Cross Blue Shield Institute (BCBSI), a subsidiary of the Blue Cross Blue Shield Association comprising a federation of 36 independent Blue Cross and Blue Shield organizations, said Solera and BCBSI's collaboration is expected to have a “significant impact” on outcomes by tailoring the help to an individual’s needs.

The alliance between the two organizations “certainly is disruptive,” Schmidt says, because addresses two key areas that have previously not been addressed in a sustainable business model. “The BCBS Institute is focused on improving the health of communities regardless of health plan coverage,” she says. “This is a departure from today’s focus where apart from their philanthropic foundation grants, health plans commonly focus their business on addressing their specific member populations.”

Solera’s business model focuses on curating a network of community providers that gets paid as covered service through claims, rather than administrative cost—a departure from the common SDOH approach of addressing SDOH through resource directory companies or mergers and acquisitions, Schmidt says. “In both situations, there is no outcomes-based distinction among the SDOH services. In the Solera curated model, there are winners and losers based upon their demonstrated outcomes.”

The two groups plan to roll out the program nationally in the second quarter of this year. The Institute will identify “food deserts,” for example, and other social services patients need. Solera will then partner with the Institute to make connections to appropriate community resources, helps track patient progress over time and creates sustainable revenue models for SDOH services providers, according to Schmitz. “By tailoring the regional resource recommendations to directly align with their wellbeing needs and preferences, the partnership is expected to have a significant impact on improved consumer health and enhanced quality of life at both the community and individual level,” she says.

Solera's marketplace model eliminates the need for health plans to evaluate, contract and manage multiple point solutions to meet the needs of diverse populations at the community level, the groups said.

Trent Haywood, MD, president of BCBSI says this kind of partnership moves the future of healthcare prevention away from the clinical setting to the community setting. “This transition means that food, fitness and transportation will become an integral component of how we evaluate holistic approaches to the health and well-being of our population.”