With continuous increase in the healthcare expenditure and the massive shift to value based care, healthcare organizations are now focused on finding ways to deliver care while factoring in and addressing Social Determinants of Health (SDOH).
World Health Organization defines SDOH as “the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life.” The CDC identifies the five key determinants of the population’s health to be: biological, behavioral, social, physical, and access/availability of healthcare services. Studies have suggested that these factors can influence 80% of the health outcomes.
Healthcare organizations are looking to address SDOH issues as they help improve health outcomes and keep a check on healthcare utilization. Addressing SDOH also goes hand-in-hand with the larger theme of value-based care and its associated incentives. Even the recent federal and state laws encourage payers and providers to work together with other stakeholders to tackle SDOH related problems.
Payers and providers now realize that treating a member or a patient no longer begins at clinics/ERs/hospitals, and they are now trying to address the root causes by focusing on SDOH that influence their member or member population’s overall health. They are starting to incorporate SDOH factors to predict the impact on a person’s holistic health, which is being done in the following ways:
- Integrating the SDOH data into EHRs
- Analyzing the patient data in conjunction with SDOH data
- Leveraging SDOH data for effective population health management
By using SDOH data, payers and providers can build models and better predict high-risk members and patients. These efforts, coupled with pointed and community-based actions and care interventions, are designed to avoid admissions or complications. By using SDOH data, healthcare organizations can provide a better experience for the patients and improve the overall quality of care.
Some initiatives taken by payers, providers, and other organizations in this area are:
- Blue Shield of California and the L.A. Care Health Plan are investing $146 million across 14 community resource centers in the Los Angeles area over the next 5 years, to address the social determinants of health issues for over 1 million people.
- UnitedHealthcare and the American Medical Association are collaborating to better identify and address the social determinants of health. The organizations are working on a way to standardize how data is collected, processed, and integrated regarding critical social and environmental factors. They are supporting the creation of close to two dozen new ICD-10 codes related to SDOH.
- Kaiser Permanente has recently launched an initiative called Thrive Local, a collection of community care services focused on addressing SDOH. This initiative will integrate clinical care with mental healthcare and community services to support SDOH related issues.
- Humana launched the Bold Goal initiative to improve the holistic health of their member population by screening for SDOH. By 2020, the Bold Goal initiative plans to improve health in these communities by 20%.
- UPMC Health Plan partnered with the Pittsburgh-based Community Human Services for the Cultivating Health for Success program. This program aimed at providing housing, case management, and linkage to healthcare to people with chronic homelessness health conditions. These initiatives resulted in an overall cost savings of $6,384 per person per year. Participants in the program also had 42% fewer unplanned health expenses.
- The national association of community health centers came up with the PREPARE (Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences) to help health centers and other providers collect the data needed to better understand and act on their patients’ social determinants of health.
From a technology perspective, the prevalence of technology-specific unmet needs in this space makes it ripe for technological disruption. The following technology trends are observed when it comes to leveraging the SDOH data, deriving insights, and making it actionable.
EHRs: Solutions where SDOH parameters and inputs can be parameterized and structurally integrated with the HER, while making the data accessible to other systems. This will help providers take a more holistic stock of patient health to provide appropriate care (making SDOH data available at POC), the providers can also deliver preventive care using proactive interventions leveraging SDOH-related information at their disposal. There is also a demand for turn-key solutions that considers SDOH and sits on top of EHR to provide a true longitudinal record.
AI and Advanced Analytics: Thanks to the meaningful use initiative, most providers capture data through EMR, and this data acts as the primary source of clinical analytics. EMRs also contain a lot of unstructured data in the forms of notes, etc., that are not generally considered as inputs to data analytics initiatives. By using AI, ML and NLP the unstructured data can be analysed along with structured data to identify SDOH affecting a patient / patient population.
Population Health Management: Integration of SDOH parameters into the population health management analytics can help providers identify populations and sub-populations that experience social determinant gaps. Organizations can then tailor their population health strategy to cater to specific groups and subgroups.
Addressing the issues at the SDOH level can prove to be extremely beneficial in the long run for improving the overall health of patients and reducing costs, but there are a number of challenges when it comes to the identification of SDOH lapses, collection of data, and implementation of remedial programs. Currently, several payers still lack the technology that can effectively capture and manage SDOH data, and only one-third of the hospitals are integrating social needs into their EHR. In most cases, the SDOH data is not captured, and in case it is captured, it is not done in a standardized format, and a lot of data that alludes to the patient’s SDOH issues are buried in the EHR as unstructured physician notes.
SDOH issues can become complex to resolve as the needs are sometimes non-clinical and are outside of managed care settings. Resolving issues require collaboration between various siloed departments with separate streams of funding. Implementation of remedial programs at the community level will be required to effectively resolve issues. Apart from a largescale implementation effort, this can pose a challenge as it will require deep understanding of the population being addressed and the buy-in of the members in the community.
To conclude, there is no question about the relevance and criticality of SDOH in the current healthcare atmosphere. Studies have established that a significant number of health outcomes are affected by SDOH, and that the probability of a given patient having an SDOH challenge is high. It is imperative that the involved stakeholders work toward addressing these issues. With reimbursements tied to value-based care delivery models, healthcare organizations should be incentivized toward this cause. We can expect more regulatory changes in this space to facilitate healthcare organizations to carefully look at SDOH factors, and eventually, the same will be incorporated into the design of value-based contracts.