“Health equity” and “social determinants of health” (SDoH) are terms often used in health care to brand measured needs in underserved populations and communities. Yet in many of those communities, the connection between people and the issues surrounding those needs is fragmented and disconnected.
Vizient is working to change this through the development of a unique vulnerability index that will serve as a singular clinical data index for SDoH at the neighborhood level. Designed to support members' existing health equity strategy, the Vizient Vulnerability Index can save hospitals and health systems from having to embark on similar indexing research.
By leveraging member data in the Clinical Data Base (CDB), the vulnerability index will provide the neighborhood-level data to understand the context around the obstacles that patients face in accessing health care and to quantify the direct relationship between those obstacles and patient outcomes personalized to their communities.
For example, when looking at health disparity in different areas, outside factors like access to transportation play a key role. Especially in rural America, people typically live farther from a primary care doctor and a hospital. This factor intersects with access to transportation which creates obstacles to accessing care. Leveraging CDB data, CDB subscribers will be able to view their member-specific profile to measure community health care needs within the scope of a hospital or its partnerships with a community and help to identify the unique clinical metrics that impact people differently in the context of different obstacles to care.
“Vizient members are really committed to making people’s lives better,” said Heather Blonsky, Vizient data scientist. “Insight from the vulnerability index will close information gaps to help them make a difference in the health of their communities.”
Critically important to the vulnerability index is the ability to go beyond the basic characterization of health disparity – namely, poverty. The CDC’s Social Vulnerability Index as well as others like the Distressed Communities Index and Area Deprivation Index do an excellent job of explaining poverty but fall short on other specific, actionable components of neighborhood-level risk factors.
“The vulnerability index is a robust database of neighborhood factors that we can pair with actual clinical information from the CDB,” Blonsky said. “It provides us great insight to show SDoH is more complex than just poverty impacting vulnerable populations. Factors influencing community health directly correlate to socio-economic, transportation, food insecurity and/or chronic health issues like diabetes, hypertension and heart disease.”
The strength of the vulnerability index is the flexibility to work the data. It’s not just a single index of information applied to the entire country. The contribution of each factor flexes geographically. What is important in New York City might not be the same as what is important in Nebraska. We have an ongoing development plan, in collaboration with our members, to add, remove, and rebalance data sources based on the unique characteristics of distinct locations as well as economic, lifestyle and health differences in those populations.
How it works
The Vizient Vulnerability Index starts with zip codes and publicly available data from the U.S. Census Bureau, U.S. Department of Housing and Urban Development, U.S. Department of Agriculture and U.S. Environmental Protection Agency. Unique to the index is the ability to integrate data from Vizient's CDB. It functions as the definitive analytics platform for performance improvement and a repository of proprietary data for members.
While other vulnerability indices lack clear insights, layering in CDB data offers the missing link for members to identify trends and patterns in utilization as well as associated cost drivers unique to the high-impact or underserved areas their facilities serve.
Vizient members recognize they have vulnerable populations within their markets. An example plays out for one of our members who has addressed readmissions reduction for their heart failure patients by increasing the availability of primary care and chronic disease management for patients in their most vulnerable neighborhoods.
“The clinics are a starting point,” Blonsky said. “The vulnerability index data likely will show that this population was vulnerable all along with transportation and access issues that led to a lack of prenatal care, poor nutrition, hypertension, diabetes and other chronic diseases. If the vulnerability index verifies these data points, then a member has an informed opportunity to improve care.”
Blonsky said insights from the data will be comprehensive and will distinguish specific vulnerabilities among our members’ patients’ neighborhoods and populations. Markets with a high incidence of diabetes, for example, can access data with additional insight to learn if housing, transportation, poverty or whether being located in a food desert are underlying causes of growing health problems.
“For all patients, knowing their zip code, exactly what neighborhoods they come from, the vulnerabilities associated with those neighborhoods, as well as clinical outcomes and utilization all provide the necessary points that correlate highly with some domain or component of the vulnerability index,” she said. “That’s where we have the data that nobody else does.”
Currently, more than 900 Vizient member hospitals subscribe to the CDB. Early next year, those subscribers will receive their custom vulnerability index profiles. For more information about the Vizient Vulnerability Index, contact Heather Blonsky.