Social Determinants of Health: Maximizing Momentum

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by Jessica Baker, Healthbox

In the healthcare industry, trends often come in waves, stirring buzz (and buzzwords) that rise and fall in interest over time. Over the last several years, the term “social determinants of health (SDOH)” has emerged to follow a similar pattern, becoming a buzzword in its own right,  with an increasing prominence in healthcare content and conferences around the world. The concept itself is not new, and has existed since the mid-1800s, first described by German scientist and physician Victor Virchow, who published a paper on the role poverty and the political economy played on the plague epidemic in Prussia.

In the following centuries, social determinants of health have garnered a growing interest in research with the goal to better understand their effects on health outcomes. While research has shown that up to 70% of a person’s health outcomes are driven by SDOH, the “social” label has made it historically difficult to see them as something that can or should be addressed in tandem with traditionally clinical efforts. To date, the burden of moving the needle on addressing factors outside of the clinical setting has fallen on social workers, philanthropists, not-for-profit organizations, and public health or government officials. Meanwhile, clinicians have been overburdened with patients unable to comply with their treatment plans and a lack of resources and training that would allow them to appropriately address the non-clinical needs of their patients.

Now, social determinants are hitting the news on a daily basis. Healthcare giants across the industry are raising their hands and stepping up to impact patient outcomes outside of the clinical setting. Technology has made it easier for health systems and payors alike to develop targeted social interventions that can make a great impact on the health of the populations they serve. In the transition from fee for service to value-based care, many health systems and payors have more of a stake in the health outcomes of their communities. When reimbursement depends on not only the success of treatment, but the overall health status of the individual,  it is crucial to not only tackle the surface-level health issues, but their root causes. Similarly, payors invested in the health of their covered communities can significantly cut down on the total cost of care by reducing the amount of time a patient spends in the hospital. Even health systems that are only partially at-risk for a portion of their population, or not at all, see the business, and societal, value in addressing social determinants of health by attracting and retaining new patient populations.

Most recently, NQF and the Aetna Foundation launched an initiative aimed at identifying innovative practices addressing social determinants of health across the country; the New Jersey Department of Community Affairs will be providing housing vouchers to the homeless along with investing to develop affordable housing in partnership with local New Jersey hospitals; and Chicago-based HCSC announced a six-month pilot extending food delivery to 40 “food deserts” in Chicago and Dallas. These initiatives, among many others including ones by Humana, Montefiore Health System, and CMS, highlight a widespread dedication to solving this problem.

While there are many exciting new initiatives in existence and on the horizon, the majority of these efforts still exist in silos. However, there are important learnings and collaborations that can arise from the sharing of approaches, metrics, and results, particularly as organizations start to develop more targeted approaches to tackling social determinants of health in their communities. Several attempts have been made to establish a nationwide social determinants collaborative to convene organizations that can share the impact their research or implementations have had.

As an example, Leavitt Partners established a National Alliance with the goal of bringing together healthcare, public health, and social services experts from across the country to break down silos and address challenges to successfully implementing and sustaining SDOH efforts. At the same time, the Healthcare Transformation Task Force, aims to serve as a facilitator and driver for the transition to value-based care, including a framework for collaborating around the advancement of SDOH measures. Others are convening around healthcare challenges, such as the AHA 2019 Innovation Challenge, which is offering up to $100,000 for a solution that will help disrupt community health and improve living conditions. Digital health companies, such as Healthify, NowPow, PolicyMap are similarly leading the charge to connect and encourage community partnerships.

All of these efforts are incredibly valuable in the drive to eradicate barriers to care and improve the health of individuals and communities. With more comprehensive access to patient data, EMR fields specific to “social” factors, and the rise in consumer-driven care, we have more opportunity than ever before to address patient needs at a broader, more holistic level. Social issues are no longer seen as a non-clinical problem. But considering all of these efforts and collaboratives, organizations face a daunting multitude of options to pursue. In addition, each organization has its own diverse patient population and a wall of big data that stands between them and a targeted SDOH initiative. In order to continue to break down silos and advance the success of existing collaboratives, organizations that are working towards solving these problems need to share their processes, progress, and results among peers. However, in order to achieve a successful, community-driven, and well-connected initiative, organizations first need to develop an internal strategic approach, collecting the right data, prioritizing their patient’s needs, and tracking metrics of success that can be shared and replicated at scale.

It is an exciting time for SDOH. This is the moment to capitalize on the momentum of social determinants to mobilize individuals and organizations dedicated to creating effective solutions, tracking metrics, and measuring the impact of each solution to move beyond the buzz and make addressing social determinants a standard industry practice for a long time to come.

 

Additional Resources

Read more: The Healthbox Root Causes of Health Report offers examples of creative and replicable ways organizations have attempted to move the lever in changing the current healthcare landscape.

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