Over the last decade, social determinants of health (SDOH) have been a major focus among health care providers, health care agencies and governmental funding organizations as they examine the conditions that determine an individual’s health. In 2020, identifying and addressing these social factors in order to promote health equity continues to be a major focus.
U.S. Initiative to Address SDOH
Background The Office of Disease Prevention and Health Promotion (ODPHP) notes that in 2008, the World Health Organization’s (WHO) Commission on the Social Determinants of Health published the report, Closing the gap on a generation: Health equity through action on the social determinants of health. This report contained research verifying social conditions such as environment, access to nutritious food and other social factors contribute to whether or not someone has good health. Through its initiative, Healthy People 2020, the Office of Disease Prevention and Health Promotion continues to address social determinants of health. What are social determinants of health? The Kaiser Family Foundation (KFF) defines social determinants of health as the social environmental factors — such as the conditions into which a person is born, where they live and where they work — that shape their health. These include, but are not necessarily limited to:
- Age
- Socioeconomic status
- Physical environment at home
- Neighborhood environment
- Work environment
- Employment status
- Access to support networks
- Homelessness
- Accessibility to health care
Current Issues in Addressing SDOH
Although healthcare providers and government agencies have taken steps to reduce the impact of these determinants on patients, there are currently limitations and challenges. Scarcity of programs responding to a patient’s direct needs Some healthcare providers work with federal and state-funded agencies to address the direct needs of a patient who has been negatively impacted by SDOH, by implementing food pantries, free prescription programs and other related programs. However, many providers do not have the means to set up these programs on their own. Need for providers to work in collaboration with agencies to identify SDOHs For instance, Humana has launched a value-based program that works with providers, reimbursing them to identify social determinants of health in patients such as: the need for transportation, inability to pay for prescription refills and other social determinants. Humana’s program promotes patient screenings and implements numerous assessments so participating providers are able to identify and address some of the social factors that negatively impact patients. This year, Humana has plans to reimburse participating providers, but it is unclear at this time exactly how that reimbursement would take place. Likewise, there are codes in place which providers use to identify these patients, but these codes are currently underused. The most commonly used code for social determinants so far is the one for homelessness. Low interoperability Social determinants of health are limited by low EHR interoperability, says an article from EHR Intelligence. There is an effort to improve interoperability in the form of connecting and exchanging data on SDOH between medical agencies and non-medical agencies, but there is still much improvement needed. Need to address the underlying causes of health care inequity According to an article in Penn Today, political scientist Julia Lynch claims that, “Giving everyone access to affordable health care will not make everyone equally healthy.” It is a known fact that people who live in poverty or are exposed to racism, for example, get sick more often. Those underlying socioeconomic factors have to be addressed first, rather than addressing political platforms in the form of Medicaid for all, expanding the Affordable Care Act, or proposing a combination of public insurance options along with private insurance, Lynch argues. These platforms themselves will not solve the problem because health care alone, Lynch insists, is not enough to address the fundamental inequalities that are linked with conditions of poor health (such as stress and cardiovascular disease). Need to reduce healthcare costs It is not just the cost and availability of health insurance, Dr. Steve Strongwater explains in his Modern Healthcare editorial, that makes health care less than accessible for a lot of Americans. It is also the cost of healthcare itself. Dr. Strongwater writes that in 2018, healthcare spending reached $3.6 trillion, translating to $11,172 per person. Dr. Strongwater emphasizes that the current fee-for-service model does not work and urges a change over to a value-based pay method.
How Are Industry Leaders Currently Addressing SDOH?
Not enough programs provide patients with immediate assistance Some healthcare providers work with federal and state-funded agencies to put in place food pantries and free prescription programs to make these resources available to patients who need them. However, many providers do not have the means to set up these programs on their own as an extension of their regular medical practices. Federal and state initiatives in transition As the Kaiser Family Foundation describes, there are a variety of initiatives that address social determinants, both inside and outside the healthcare system. Outside the healthcare system, KFF summarizes, there is a growing trend to shape policies and practices in non-health sectors to promote health equity within the healthcare system itself. KFF adds there are Federal and state initiatives that address social needs. There are also Medicaid-specific initiatives that address social needs of patients: these include options under Medicaid; models under the Center for Medicare and Medicaid Innovation and reform initiatives for the Medicaid delivery system and payment. However, as everyone is aware, these Medicare and Medicaid models are a major political focus and are subject to big changes. Low interoperability continues As healthcare systems continue implementing social determinants of health into patients’ health records, they are facing problems like interoperability as they try to incorporate their SDOH data into their electronic health systems, EHR Intelligence reports. The EHR article cites Brian Dixon, Ph.D, Director of public health at the Regenstrief Institute. Dixon states that even though healthcare providers and organizations may have datasets that are available through the government or through local and community organizations, the data does not get brought into the EHR system very frequently. Summarizing the problem, Dixon observes that, “There is not a lot of interoperability between clinical organizations and non-healthcare or non-clinical organizations.”
Addressing SDOH: Solutions
Like the problem, the solution for addressing SDOH is multifaceted: Support legislation that addresses SDOH Healthcare providers and agencies that seek to address SDOH need to keep tabs on the changing Federal and state policies that fund and support procedures that facilitate screening for and addressing SDOH. Address the underlying causes of SDOH Furthermore, it is important to stay aware that the underlying causes of SDOH need to be addressed instead of just addressing SDOH exclusively. Finding more ways for providers to identify and make note of SDOH in patient files is a step towards recognizing the underlying causes that contribute to them. Make technical innovations in ERS a priority As ERS continues to evolve, there will be more technology available to increase interoperability and communication between one provider and another or between one provider and social and non-medical agencies who are focused on addressing SDOH. By updating to the best electronic health record systems available, organizations will be able to effectively keep track of and share important patient data. Move away from a fee-for-service model Healthcare providers, businesses and state and Federal funding agencies must continue coordinating their efforts to identify SDOH, to enhance interoperability. This also means moving away from a fee-for-service model while moving towards a value-based system. This can be done with programs such as the innovative Humana program, which reimburses providers for identifying SDOH. Increase networking and collaboration Networks and alliances continue to grow in an effort to address SDOH. For instance, Fierce Healthcare describes how Dr. Karen DeSalvo, Chief Health Officer at Google and former Assistant Secretary for the Department of Health and Human Services (HHS), is one of the founders of a private-public collaborative organization that is made up of public health organizations, social services groups and healthcare organizations. The organization, focused on addressing social determinants of health, is called the National Alliance to Impact the Social Determinants of Health (NASDOH).
Final Note
With a multi-faceted solution that includes keeping up with innovation, changing from a fee-for-service model to a value-based system and understanding the underlying causes of SDOH, the key lies in communication and keeping up with innovative technologies that facilitate collaboration and sharing of data. Healthcare providers must pass on their observations of patients to non-medical and social agencies that are actively addressing SDOH and their underlying causes. Staying on top of innovative changes in the way vital information is shared among all the stakeholders is more important than ever in 2020, especially when state and government funding for programs through Medicare, Medicaid, and the Affordable Care Act is undergoing change.