“Providers, payers and community groups are coming together using principles of population health — namely social determinants of health(SDOH) data — to find at-risk people. The stakeholders share data on factors like poverty rates and transportation availability to spot potential problems before they spiral out of control. And there is some evidence the programs work and save money.
“That combination of data helps you flag who are higher-risk cases,” said Rosemarie Day, president of Day Health Strategies and former chief operating officer at MassHealth, Massachusetts’ Medicaid program, in an interview.”
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