Chances are, if you’re a physician, you have long known social determinants of health (SDoH) have an outsized impact on health outcomes. In fact, research suggests medical care accounts for only 10-20 percent of health outcomes while the other 80-90 percent are attributed to demographic, environment and socioeconomic factors.
It may be tempting to think that the impact of social determinants – food insecurity, transportation, financial literacy, loneliness and more – is concentrated within at-risk populations such as Medicaid recipients. Yet, at least two studies challenge this idea:
- 68 percent of patients have at least one social determinant of health challenge, according to a study of 500 random patients.
- A national study commissioned by Kaiser Permanente found 68 percent of adults had at least one unmet social need, and these needs span income levels.
With the majority of adults reporting unmet social needs, it stands to reason that physicians and their staffs are increasingly being called upon to address patients’ social determinants of health. Undoubtedly the evolution to value-based care payment models, which are expected to account for 59 percent of healthcare payments by 2020 and increasingly mean physicians are compensated for quality and outcomes, has heightened the focus on using SDoH data to improve healthcare quality, cost and patient satisfaction.
Physicians: ‘Surely, someone else is better positioned to address SDoH’
It is critical to note that physicians understand the importance of unmet social needs but also fundamentally believe it is not their responsibility to address social determinants. A study by the Leavitt Partners, Social Determinants Matter, But Who is Responsible? 2017 Physician Survey on Social Determinants of Health, showed the majority of physicians believe SDoH matter for their patients and SDoH assistance would help their patients, but also that someone outside the physician’s office or practice is best-positioned to help patients.
The Surprising Connection Between Physician Burnout and Social Determinants of Health
In many ways, value-based care depends on the engagement and activation of physicians, who by objective measures are increasingly burned out and frustrated by the increasing administrative demands of medicine. That’s why it is so encouraging to learn that mitigating patient social needs also benefits the physicians who treat them.
The January-February 2019 issue of the Journal of the American Board of Family Medicine reported
"improving clinical capacity to respond to patients’ social needs may reduce primary care physician burnout."
The national study of 1,298 family physicians found burnout was less likely to be reported by those “with a high perception of their clinic’s ability to meet patients’ social needs,” suggesting that addressing patients’ social determinant challenges may help reverse epidemic levels of physician burnout.
Social Determinants of Health in Action
A good place physician practices can start is with a one-minute patient survey. Research published in the Annals of Family Medicine discussed the efficacy of giving patients a 60-second survey with questions about “whether or not they needed help within the last 30 days regarding day care, domestic violence, education, employment, food, housing, legal services, safety, substance abuse, transportation, utilities or other such social need.” Sarah R Reeves, MSN of the Virginia Commonwealth University department of family medicine and population health, and her colleagues, wrote,
Little to no patient instruction is required to complete the 15-item checklist. Ease of survey use by general internal medicine nurses demonstrates low burden on staff and workflow. This survey could easily be used in primary care settings, through front desk paperwork or with rooming staff. Similarly, primary care practices with limited time and resources can prioritize and target community partnerships of most value to their patients once rates of unmet social needs are identified.
SDoH and Medication Adherence
Physicians in value-based care arrangements are likely to find resources at the health plan and a readiness to partner to identify and address social determinants. Take medication adherence. Research suggests the annual cost of medication nonadherence is $100 to $289 billion. For many patients, the failure to take prescribed medications is tied to social determinant of health challenges, commonly a lack of transportation. A patient record that integrates claims, clinical and social determinant data in real-time can help a physician practice or health plan care manager identify the reason(s) and the solution(s).
A combination of publicly-available county and zip code data and patient-level information can show, for example, that Charles Green, a 58-year-old fictional patient with congestive heart failure, hypertension and type 2 diabetes, has social determinant indicators for housing and transportation. The care manager is able to easily drill down in his patient record to learn:
- Charles has moved three times in the past 12 months,
- There is no known licensed driver in his household,
- The closest in-network pharmacy is nearly a mile away from the patient’s current residence.
Social determinant information presented in this manner suggests transportation may be why Charles has not recently filled his prescriptions.
Charles’ care manager contacts him to confirm that, in fact, he does not have access to a car and the nearest bus stop is eight blocks away. Within the patient record, she is able to arrange for his medications to be sent to his home as well as create a referral to a social services organization that provides transportation to physician visits.
Social Determinants: What’s Next?
Increasingly social determinant data is being used to enhance the development of risk models. Health vendors are aggressively developing capabilities to incorporate SDoH data into analytics insights. Imagine a population health analytics platform that is able to tell the physician the patient is at risk to miss the next appointment because of a transportation barrier. For many physicians, SDoH data will have the greatest value when aiming to predict which patients will develop a quality care gap, and what will be the most effective way to engage the patient - communication channel, type of message, messenger, and more - to help them adhere to a care plan.
For more information, download Geneia’s white paper, Social Determinants of Health: From Insights to Action.