Care Beyond Clinical: Social Determinants of Health
Understanding and connecting social determinants as a path to true, patient-centered care
“It’s all in the genes” … but not really.
Did you know that in the U.S., life expectancy is more affected by your place of birth than your gender, race or genetics?
When there is a 35-plus year gap in life expectancy between the most and least economically advantaged U.S. populations — not to mention similar and severe disparities in and between other countries around the world — what other factors are at play here?
In 2003, the World Health Organization led the charge researching exactly this when it developed the commission on Social Determinants of Health, or SDoH as it’s since been referred. To improve the health of the world’s most vulnerable people, the committee drilled down the most concerning social factors impacting individuals’ health — the conditions in which people are born, grow, live, work and age. In essence, what is a person’s employment status? Do they have access to adequate housing, transportation, and food?
Various studies have revealed that:
-Up to 68 percent of patients suffer from at least one social determinant of health challenge
-One in five patients could be at high risk with SDOH-related health problems
– SDoH contribute to:
– 80 percent of our overall health outcomes, as opposed to actual clinical care
– One-third of patient deaths
As the health care industry is realizing the “value” in value-based care and shifting focus to treat the entire patient, the case has absolutely been made to better understand, report and share their underlying social determinants.
Health insurance companies becoming health care companies
United Healthcare CEO, Steve Nelson, challenged attendees at this year’s Dreamforce event, “The macro trends in our country are aging, more chronic disease, and (we) can’t just focus on the traditional plays that we’ve relied on for health care. (We)’ve got to start thinking about the entire person, their surroundings, and the things that affect their health besides just the condition they’re in.”
Nelson then gave a poignant example of how SDoH can influence medical outcomes. One of United’s Medicaid program recipients in Arizona was admitted to the hospital 50 times in 12 months. The individual kept showing up in the ER with anxiety which presented as a heart attack. Upon investigation, it was revealed this individual was also jobless and homeless, and could also benefit from assistance with housing and back-to-work training. In treating the root of the problem for this particular individual, he was not admitted to the ER again over the following 12 months.
This is what addressing SDoH and moving to both patient-centered and value-based care looks like, which Nelson argued should not be considered “controversial” or mutually exclusive concepts, but related and complementary. Ideally, patients receive better outcomes and experiences (because who wants to go to the hospital 50 times in a year?), costs are lowered at the federal and state levels, across the entire continuum of care, and ultimately reflected in lower health insurance premiums for patients as well.
How do we then move conversations about SDoH to the patients who are most likely to have health issues and most likely to take advantage of support, when offered?
Partnerships between orgs and with data
A couple of key themes have emerged to provide these solutions: partnerships of both the commercial and the public–private varieties, between groups such as social workers and government agencies for example, and better using data we already have available.
Aunt Bertha is a social services directory app that is nailing both of these themes. With over 1.5 million users, they aim to connect people in need with all of the programs that could potentially serve those needs. You simply enter a zip code, which unlocks thousands of assistance services in that area, across a wide range of areas from food, housing, money and education, to health and legal assistance.
Missed health care appointments cost more than $150 billion a year? Let’s better align transportation and other solutions — at the point of care — to eliminate these gaps. Take the recent partnership between ride-hailing app, Lyft, and the American Cancer Society (ACS) as an example here. Whereas the ACS says lack of transportation is one of cancer patients’ biggest barriers to receiving quality care, these patients can now use Lyft’s Concierge platform to request rides to treatment appointments.
Recent legislation has made the connection more apparent between access to a broadband connection for people in rural areas, and receiving better health care, including how these populations can benefit from advances in telemedicine.
Imagine the possibilities if a comprehensive overview of potential social needs was included in a patient’s EMR, with a clear path for case managers to obtain solutions, in real-time?
‘Determinant’ doesn’t mean ‘predestined’
As the SDoH acronym has garnered more attention in recent years and months, some have argued that “determinants” is too strong of a word — that a better alternative might be “influencers” or “predictors.”
Their reasoning? While social factors can increase the probability of poorer health outcomes, that doesn’t mean that individuals from poorer neighborhoods with inadequate infrastructures, less access to medical care or more nutritious food sources are doomed, as though their fate has already been “determined.” Some people can overcome these odds. And we’re all about reiterating that narrative, continuing to ask the related and tough questions in the health care IT industry — what can we do to improve their odds? And how do we work together to make sure we’re doing enough?