From Insights to Action | Geneia

Social Determinants of Health: From Insights to Action

March 26, 2019
Aurel Iuga, MD, MBA, MPH, CMQ, Chief Medical Officer


Use SDoH data to personalize patient care and improve outcomes

If you’re in healthcare, you know social determinants of health (SDoH) are a very popular topic these days. It may be tempting to say, “Enough already,” but I urge you not to. 

SDoH drive 80+ percent of health outcomes

That’s because researchers believe social determinants drive more than 80 percent of health outcomes. Medical care alone is insufficient to improve health as it is estimated to account for only 10-20 percent of the modifiable contributors to improved health outcomes. “The other 80 to 90 percent are sometimes broadly called the SDoH: health-related behaviors, socioeconomic factors and environmental factors.” In other words, smoking, exercise level, loneliness, financial security, access to transportation, sidewalks and playgrounds and more have a tremendous impact on health outcomes.

Additionally, there are three other reasons that help to explain the strong interest in social determinants of health:

  • Health costs: Healthcare costs are high, and they’re expected to keep increasing. In 2017, U.S. healthcare costs were nearly $3.5 trillion. By 2026, costs are expected to climb to $5.7 trillion, representing nearly 20 percent of the economy.
  • Prevalence of social determinants of health: 68 percent of patients have at least one social determinant of health challenge, according to a study of 500 random patients; 57 percent have a moderate-to-high risk for financial insecurity, isolation, housing insecurity, transportation, food insecurity and/or health literacy.
  • Value-based care: The evolution to value-based care continues and the payment model is expected to account for 59 percent of healthcare payments by 2020. Large payers like Aetna and United are aggressively moving their provider contracts to value-based care and the Centers for Medicare and Medicaid Services (CMS) remains committed to value-based programs.

Addressing Social Determinants of Health: Success Stories

Given the profound impact social determinants have on patient health outcomes, I wholeheartedly agree that addressing a patient’s housing, transportation and food needs reduces health spending. Research has shown this to be true.

Payers, in particular, lead the way with pilots and research studies demonstrating the effectiveness of managing patient social determinants. One of the more notable payer success stories is WellCare’s program, which referred 33,000 people to 106,000 community-based programs and services. A 2016 study by the Robert Wood Johnson Foundation showed the program reduced:

  • Emergency department use by 17 percent,
  • Emergency spending by 26 percent,
  • Inpatient spending by 53 percent and
  • Outpatient spending by 23 percent.

Social Determinants of Health: Insights to Action

It’s an exciting time to be working with social determinants. The ability to proactively identify and address the SDoH barriers for populations of patients has never been greater. Technology has enabled healthcare organizations to scale their efforts to engage greater numbers of patients.

Take medication adherence. Research suggests the annual cost of medication non-adherence is $100 to $289 billion. For many patients, the failure to take their prescribed medications is tied to social determinant of health challenges, commonly a lack of transportation. A complete patient record that integrates claims, clinical and social determinant data in real-time can help a care manager identify the reason(s) and the solution(s).

For more information about how healthcare organizations, physicians and care managers successfully use social determinant data to more effectively manage patient populations, personalize healthcare for individuals and improve outcomes and costs, download Geneia’s new white paper, Social Determinants of Health: From Insights to Action.

Download the white paper


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