Understanding family history and genetics are important factors in assessing and predicting health, however there are other factors that have been shown to have an even greater influence. According to a study published in the New England Journal of Medicine, “60% of a patient’s healthcare outcome is driven by their behavior and social and economic factors, 10% by their clinical care, and 30% by their genetics.” (1)
Multiple studies demonstrate that there are large disparities in health status among specific races and ethnic groups, and socioeconomic classes which closely align with where they live. The physical features and social patterns of specific neighborhoods have been shown to impact health outcomes. Air and water quality, climate, housing, crime rate, and the existence of recreation areas all contribute to life expectancy.
Zip codes are becoming important indicators. A 2011 study reported that “Life expectancy gaps of up to 25 years have also been identified between different neighborhoods within the same city.” (2) Given this evidence, 5-digit zip codes may not be enough. The zip +4 codes are more precise as they narrow geography down to the radius of a few blocks or specific smaller areas.
Ensuring accessibility can result in better outcomes for members and injured workers. This is where provide network management can play a role. Capturing provider zip codes beyond 5-digits can help in ensuring geographic coverage of a provider network or provider panels.
Nine digit zip codes can help teams analyze provider coverage against the geography of a health plan or workers’ compensation programs population. If the provider network does not cover these more at-risk geographies, it opens the opportunity to offer incentives and supportive programs, such as transportation vouchers to ensure access to care. Another value that provider network management can provide is the ability to track provider network utilization by geography. Advanced digital provider search solutions have analytics capabilities that measure provider access by geography and specialty. By comparing utilization against individual enrollment, care/case managers can decide if one on one outreach and check-in is needed.