Social Determinants

Social Determinants of Health

Using TiqiPay to help mitigate SDOH (Social Determinants of Health)

For many populations, the ability to access healthcare and maintain health is inextricably linked to individual’s social context. Food deserts, transportation challenges, limited health services, demanding work schedules and limited resources all impact individual’s ability to achieve and maintain health.

Health plans and government funders recognize that overall health care spending (for which these organizations are financially liable) can be positively impacted by directing resources to mitigate the impacts of social determinants. However, ensuring resources are allocated for the reasons and individuals intended can be difficult.

Payer claims systems can be configured to pay non-healthcare claims. But enlisting non-healthcare service providers accustomed to payment at the time of service into the retrospective claims-based payment system faces resistance from those accustomed to payment at the time of service.

The TiqiPay platform provides payers and governments with the tools to allocate resources to constituents to use on SDOH, with controls to ensure resources are spent on qualified providers:

Define categories of services appropriate to the communities served
- Food
- Transportation
- Housing
- Healthcare
Sign up service providers to accept payment through TiqiPay
Allocate resources though “vouchers” directly to constituents for their personalized needs
Control when and where “vouchers” are redeemed
- By type of service
- By time
- By location
- By amount
Include and enforce member cost share, (copay, deductible, and coinsurance) requirements
Track redemptions in real time
- Monitor redemptions by service provider
Replenish resources automatically on a schedule or based on other inputs
Mitigate fraud and abuse
- Audit trail of redemptions captures time, date, location, and provider
- Individual ability to “spend” constrained by the volume of vouchers assigned

For constituents:

TiqiPay wallet shows the specific services and amounts available at all times
Search feature connects constituents to service providers in their area
Patients compare prices across providers, including total price and individual out-of-pocket expense
Payment, combining sponsor portion and member portion, is completed at time of service

For service providers:

Participate in programs for SDOH
Promote services to new and existing customers
Receive payment in real time and time of service
Avoid fraud (such as impersonation fraud) as constituent payment is tied to the constituent themselves

Contact us to learn more about how TiqiPay can help realize meaningful reductions in medical expenses while improving constituent health.