Community Health Services /SDOH for Patients
Health disparities and social determinants of health (SDOH) continue to significantly impact patient outcomes by influencing access to care, quality of treatment, and overall health status. Socioeconomic status, education, environment, and social support systems are some of the factors that play critical roles in determining an individual’s health outcome.
These factors also impact physician practices, affecting the ability to close gaps in care, improve quality measures and more. Supporting patients’ social determinants of health can help improve quality of care, quality measures, patient satisfaction and practice revenue.
The Physician Alliance is pleased to provide a multitude of resources to support to member practices assisting patients with addressing social determinants of health.
The Physician Alliance community health worker can provide direct (non-medical) support to your patients
TPA’s certified community health worker helps practices support patient social determinants of health needs by working with patients to address their needs and concerns that are impacting their overall health. There is no charge to TPA PGIP member practices for this service.
What support is available to patients?
TPA can assist patients with a variety of non-medical needs. Examples include food insecurity, housing insecurity, transportation, education assistance, employment assistance and access to supplies such as clothing, home supplies, diapers, baby formula, transportation, education, and employment.
Request patient support
Primary care and specialty practices participating in BCBSM’s Physician Group Incentive Program (PGIP) through The Physician Alliance can submit a community heath referral form stating a patient’s need(s).
- To submit a request for community outreach to a patient, log into TPA’s member portal at tpareporting.org.* Once logged in, click on ‘SDOH form’ on the left side menu and complete the form.
Once a referral form is submitted, TPA’s community health worker will contact the patient regarding their need(s) within 2-3 business days.
- TPA will alert the practice via secure email about the patient contact and community resource provided to the patient.
- TPA will follow up with the patient one week after the initial contact to ensure they have been helped.
*Please contact your practice resource team member for assistance accessing the portal.
Resources for patient education
The following resources were created to help practices promote the support available through The Physician Alliance’s community health worker. Practices can let patients contact our community health worker directly to request non-medical support (practices will be alerted if a patient directly requests support). The flyers can be posted in waiting areas, exam rooms, bathrooms, labs and elsewhere.
- Flyer promoting community health services to patients (with phone number to call TPA’s community health worker directly). [*Please contact your practice resource team (PRT) member if you need a laminated version of this flyer.]
- Flyer promoting community health services to patients (with phone number to call TPA’s community health worker directly) – with tear-off phone number tabs.
- Graphics to promote community health services on practice social media, website, patient portal and more.
Resources for practice staff supporting SDOH
- Flyer for practice staff to be aware of available patient support from TPA’s community health worker.
- View a printable guide on how to submit a community health assistance referral form in TPA’s member portal (log into TPA’s portal to access form).
- View a short video on how to submit a community health assistance referral form in TPA’s member portal.
- Social determinants of health Z codes tip sheet