Choos­ing the Right Ap­proach to So­cial De­ter­mi­nants of Health

Modern Healthcare - - News -

When it comes to ad­dress­ing so­cial de­ter­mi­nants of health, care co­or­di­na­tion for low-in­come or geri­atric mem­bers and nutri­tion ed­u­ca­tion top the in­vest­ments made by pay­ers and providers, ac­cord­ing to a sur­vey con­ducted for En­volve Health by Mod­ern Health­care Cus­tom Me­dia. But are these the right ar­eas for in­vest­ment?

The an­swer de­pends largely on the pop­u­la­tion be­ing tar­geted and the com­mu­ni­ties served, ex­perts say.

“There’s not a magical strat­egy that is go­ing to work for ev­ery com­mu­nity in the United States,” says Rashi Venkatara­man, ex­ec­u­tive di­rec­tor of pre­ven­tion and pop­u­la­tion health, Amer­ica’s Health In­sur­ance Plans (AHIP). “So while the def­i­ni­tion of so­cial de­ter­mi­nants of health might be the same, as you move from Topeka to New York City to Des Moines, each com­mu­nity has its own chal­lenges.”


Both pay­ers and providers are de­ploy­ing a wide range of strate­gies to ad­dress so­cial de­ter­mi­nants of health, in­clud­ing sub­stance abuse sup­port, trans­porta­tion to and from med­i­cal ap­point­ments, and pre­na­tal ed­u­ca­tion, ac­cord­ing to the sur­vey.

For the ma­jor­ity of the 600 pay­ers and providers who re­sponded to the sur­vey, their or­ga­ni­za­tion’s top fo­cus is on ad­dress­ing the im­pact of so­cial de­ter­mi­nants of health on mem­bers’ abil­ity to man­age chronic con­di­tions (50 per­cent) and be­hav­ioral health (20 per­cent).

Re­spon­dents view so­cial is­sues such as in­come and in­come dis­tri­bu­tion, ad­dic­tion, lack of fam­ily struc­ture/sup­port, health lit­er­acy, and ac­cess to care as those that most af­fect mem­bers’ health con­di­tions.

These an­swers sur­prised some ex­perts. For ex­am­ple, ac­cess to healthy food and safe and re­li­able hous­ing are two of the top so­cial is­sues im­pact­ing Med­i­caid pa­tients’ health out­comes, ac­cord­ing to Fran­cis Rienzo, vice pres­i­dent of ad­vo­cacy and gov­ern­ment re­la­tions and in­terim CEO for Med­i­caid Health Plans of Amer­ica (MHPA), yet sur­vey re­spon­dents ranked them ninth and 10th, re­spec­tively. Mean­while, so­cial ex­clu­sion ranked 14th among the top so­cial is­sues im­pact­ing mem­bers’ health out­comes, yet re­cent re­search high­lights the im­pact of so­cial ex­clu­sion on mem­bers’ men­tal health and mor­tal­ity rates from con­di­tions such as car­dio­vas­cu­lar dis­ease, res­pi­ra­tory dis­ease, can­cer, and asthma. 1

Other re­sponses to the sur­vey sug­gest providers and pay­ers are ad­dress­ing is­sues that are more di­rectly re­lated to pro­vi­sion of care rather than broader so­cial is­sues. “That sort of misses the point in that these are not so­cial de­ter­mi­nants of health­care; they’re so­cial de­ter­mi­nants of health,” says Matthew W. Kreuter, PhD, MPH, fac­ulty di­rec­tor for the En­volve Cen­ter for Health Be­hav­ior Change, a re­search col­lab­o­ra­tion be­tween Brown School at Wash­ing­ton Univer­sity in St. Louis, The Cen­ter for Ad­vanced Hind­sight at Duke Univer­sity and Cen­tene Cor­po­ra­tion.

Why is there so much vari­a­tion in payer and provider in­vest­ments in and pri­or­i­ti­za­tion of so­cial de­ter­mi­nants of health? Re­cent re­search sug­gests it may be be­cause payer and provider ef­forts to ad­dress so­cial de­ter­mi­nants are still a rel­a­tively new phe­nom­e­non. While 88 per­cent of hospi­tals say they screen for so­cial needs, screen­ings aren’t ap­plied con­sis­tently, even among tar­get pop­u­la­tions. 2

Lim­ited ac­cess to data around so­cial de­ter­mi­nants also gives providers a nar­row view of the so­cial is­sues most af­fect­ing their com­mu­ni­ties. So do bud­getary con­straints and lack of re­im­burse­ment, ac­cord­ing to 55 per­cent of sur­vey re­spon­dents.

“I think you’re go­ing to see more progress around ad­dress­ing so­cial de­ter­mi­nants of health in the next cou­ple of years. But right now, these ini­tia­tives are tough to im­ple­ment be­cause the open­ness to in­no­va­tion is some­what lim­ited,” Rienzo says.


How can pay­ers and providers more ef­fec­tively ad­dress so­cial de­ter­mi­nants of health? Here are four strate­gies to con­sider.

Ed­u­cate team mem­bers on so­cial de­ter­mi­nants of health.

Ad­dress­ing the so­cial is­sues that most im­pact mem­bers’ health must start with a com­mon un­der­stand­ing of what so­cial de­ter­mi­nants of health means. The World Health Or­ga­ni­za­tion de­fines so­cial de­ter­mi­nants of health 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.” This com­mon un­der­stand­ing is vi­tally im­por­tant to pri­or­i­tiz­ing so­cial de­ter­mi­nants ini­tia­tives. For ex­am­ple, while nutri­tion ed­u­ca­tion—a so­cial de­ter­mi­nants of health strat­egy de­ployed by 56 per­cent of re­spon­dents—can help mem­bers make healthy food choices, if mem­bers live in a food desert and lack ac­cess to nu­tri­tional foods, the pri­or­ity should be on pro­vid­ing ac­cess to healthy food rather than ed­u­ca­tion.

Take a 360-de­gree view of the so­cial is­sues im­pact­ing your pop­u­la­tion.

Col­lab­o­rate with pay­ers, providers, and com­mu­nity ser­vice or­ga­ni­za­tions to ac­cess a broad range of data around so­cial de­ter­mi­nants of health, and work with these en­ti­ties to:

Iden­tify which so­cial de­ter­mi­nants of health have the great­est im­pact on mem­ber out­comes

De­ter­mine the right ap­proach for in­vest­ment

Mea­sure the ef­fec­tive­ness of tar­geted in­ter­ven­tions

“Health­care is re­ally mov­ing to­ward a whole-per­son ap­proach to care, and the way in which or­ga­ni­za­tions ad­dress so­cial de­ter­mi­nants of health should re­flect this broader view,” Rienzo says. “It’s not just about do­ing the smart thing for the pop­u­la­tions you man­age; it’s about do­ing the right thing.”

In­cor­po­rate so­cial sup­ports into clin­i­cal models.

Look for in­no­va­tive ways to part­ner with lo­cal re­sources in ad­dress­ing gaps in ba­sic needs, such as trans­porta­tion, safe hous­ing, pre­na­tal as­sis­tance, and child care for par­ents who work. In some com­mu­ni­ties, physi­cians are able to “pre­scribe” as­sis­tance from lo­cal agen­cies to ad­dress so­cial is­sues that most im­pact a mem­ber’s health. 3

Be mind­ful of re­source lim­i­ta­tions.

Be care­ful not to du­pli­cate ex­ist­ing ef­forts, given the lack of fund­ing and staffing avail­able. “In mak­ing in­vest­ments around so­cial de­ter­mi­nants of health, it’s im­por­tant to con­sider change­abil­ity: How likely is it that your ef­forts will re­sult in pos­i­tive change for a spe­cific pop­u­la­tion?” Kreuter says. “For ex­am­ple, safe and re­li­able hous­ing is im­por­tant to peo­ple’s health, but it’s dif­fi­cult—and costly—to make a sub­stan­tial im­pact on hous­ing re­sources in your com­mu­nity.”

If you would like to learn more about this sur­vey and of­fer feed­back on this ar­ti­cle, please visit ModernHealth­care. com/En­volve.

Sources :1“So­cial Ex­clu­sion Height­ens Risk of Death Across Many Health Con­di­tions ,” Na­tional In­sti­tute for Health Re­search, Jan .31,2018.2 So­cial De­ter­mi­nants of Health: How Are Hospi­tals and Health Sys­tems In­vest­ing in and Ad­dress­ing So­cial Needs? Deloitte, 2017. 3Bachrach, D ., Ad­dress­ing Pa­tients’ So­cial Needs: An Emerg­ing Busi­ness Case for Provider In­vest­ment, The Com­mon­wealth Fund, May 29, 2014.

To­tal An­swer­ing: 521

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