Zip code lottery

The US spends more money on healthcare – -~20% of its GDP ($4.5T) annually, according to The Commonwealth Fund – than any other high-income country. The next highest, Germany, spends 12.8% of GDP. Despite this, adults in the US are most likely to suffer from multiple chronic conditions. And the US has the lowest life expectancy of any OECD member country at birth.

Clinical care is, however, estimated to impact only 10-20% of our health outcomes. Socioeconomic factors, physical environment, and lifestyle behaviors – called ‘Social Determinants of Health (SDoH)/Social needs’ determine the remaining 80-90% of health outcomes. Here is SDoH prevalence across the US:

SDoH has tremendous impacts on the health of people and the healthcare system as a whole. People with food insecurity have a 50% chance of diabetes. Those suffering from loneliness are 64% more likely to suffer from clinical dementia. Those who miss appointments due to transportation issues cost the healthcare industry US$150 billion annually.

People with the most social needs tend to live in poorer neighborhoods and tend to be from marginalized and vulnerable sections of the population. For example, Roxbury, Massachusetts – a poor neighborhood with high levels of unemployment, food insecurity, and crime has a life expectancy of just 59 years, while Back Bay – a wealthy neighborhood just five miles from Roxbury with no food insecurity, low unemployment rate, and low crime rate has a life expectancy of 91 years.  

Understanding this information can be vital for US healthcare payors and providers to improve the health outcomes of their members and reduce healthcare costs. However, most healthcare companies do not have a holistic view of their members. Data is stored in siloed systems that are difficult to integrate. Moreover, there is no standard methodology to identify high-risk members and geographical hotspots, making it difficult for healthcare companies to intervene and help members.

Recognizing this, Fractal has developed an integrated population health management suite leveraging data, AI, and human-centered design.

It combines data from over 100 different sources, including the organization’s internal and public data sets, and helps healthcare organizations identify high-risk members and high-risk geographies through an interactive map. For example, a user looking at the incidence of diabetes and food insecurity in a region can identify the zip codes with a high disease prevalence and particular social needs and even filter down to those incidences requiring ER visits. Users can then get a list of members who live in these zip codes, connect with them, and perhaps enroll them in a food insecurity initiative or a diabetes management program.

The benefits have been significant. One large US healthcare organization has more than 250 teams using the solution, and by closing SDoH gaps, the organization has impacted more than one million members. The solution was a key differentiator for the organization to win new government contracts and expand its business in new states. In months and years to come, Fractal expects to onboard more healthcare organizations and, as a result, impact many more lives worldwide.