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How do you capture social determinants of health insights to improve care?

Health Equity and SDoH Healthcare Analytics Population Health Management

Since 2011, Community Health Plan of Washington (CHPW) and the Community Health Centers (CHCs) have shared claims-based and EHR data via a shared analytics platform. This collaboration allowed CHPW to administer an innovative P4P program, drive value-based payments, run a strong risk documentation program, and support quality initiatives across the network. But with social determinants of health (SDoH) heavily influencing patient outcomes, CHPW wanted to do more to support its providers with broader issues in their communities.

CHPW engaged and partnered with providers to capture and work with SDoH data to enable community partners and CHCs to mobilize community-based resources.

Community Health Plan of Washington explains:

  • How SDoH can impact clinical outcomes
  • Why it’s important to consistently document SDoH data
  • How to develop resources to address barriers to SDoH data capture at the practice
  • How to use SDoH data to collaborate across a network
Jennifer Polello, MHPA, PCMH CCE, MCHES
Senior Director of Quality and Clinical Transformation