Getting Upstream of Social Determinants of Health

June 03, 2019 - Nearly 30 years ago, I began my healthcare career as a nurse. I didn’t use the term social determinants of health, nor did I need a fancy algorithm to tell me that someone without reliable transportation, adequate housing, or access to fresh fruits and vegetables struggled more to maintain good health. I saw firsthand and every day the influence these factors wielded.

Despite the great compassion that called me to healthcare, helping patients with housing, clothing, and food were problems that were challenging back then, based on the lack of data and resources that were available.

Coupled with awareness of social determinants of health (SDOH), clinical research and healthcare innovation has helped to change the landscape for the better. Research and technology are helping to reveal the depth of the impact social factors have on health and healthcare costs. We now have research and evidence to support what we have long suspected:

• Social determinants matter more to health outcomes than medical services
• These factors drive more than 80 percent of health outcomes
• 68 percent of patients face at least one barrier related to social determinants, according to Waystar’s 2018 Consumer Perspectives on How Social Determinants Impact Clinical Experience. Of these, 57 percent have a moderate-to-high risk for financial insecurity, isolation, housing insecurity, transportation, food insecurity, and/or health literacy

At the same time, payment reform increasingly emphasizes value over volume, driving payers and other healthcare organizations to seek out new and better ways to improve health outcomes. It’s the perfect storm for innovation.

Around the country, pockets of payers, physicians, and hospitals are rising to the challenge and improving the health of people and populations they serve by helping to address life’s most basic but critical needs — housing, clothing, food, isolation and transportation — with some surprising results, including the research showing addressing patients’ social needs may also reduce physician burnout.

As payers, physicians and healthcare organizations pick up the mantle and provide care from a holistic perspective, people and populations are becoming healthier, cost and quality metrics are improving and physicians are becoming happier. 

For example, Children’s Hospital of Wisconsin developed an integrated, scalable, pediatric social health approach to systematically screen for and address essential human needs as a standard part of clinical care. The internal pilot program revealed:

• Unmet social health needs correlate with increased healthcare utilization and poor health prior to interventions.
• Social health screening correlates with statistically significant decline in the total cost of care for patients with identified social needs.
• Cost savings for patients with two to three identified social needs was more than $1,000 per year.

Further, the pilot explored how physicians and patient families viewed social health screening as part of standard care delivery. It found:

• 99 percent of physicians believe that addressing unmet social needs has the potential to impact health outcomes.
• 93 percent prefer to work in a health system that has a process for addressing social needs as part of standard care
• 90 percent of families believe being connected to community resources could improve their child’s and family’s health
• 91 percent of families prefer to come to a clinic that asks about their resource needs

Innovation around social determinants of health

Turns out, I need fancy algorithms after all. Algorithms leveraging deep-learning and artificial intelligence excel at consuming large, seemingly unrelated, data sets and pinpointing patterns at speeds, scale and precision never imagined. These patterns, in turn, help reveal a complete member view to physicians and payer care managers to help identify social needs barriers and community resources to address them.

About Geneia

For more information, download Geneia’s white paper, Social Determinants of Health: From Insight to Action.