- Most medical professionals agree that efforts to address the social determinants of health (SDOH) will be critical to meeting value-based care demands and improving patient care outcomes.
Healthcare experts also agree that attending to these social needs is the right thing to do, acting on a philanthropic impulse.
The proof is in the pudding. From physician offices and hospitals to large medical systems and nationally-recognized payers, efforts to address the SDOH at scale have taken over. These healthcare providers are investing heavily in projects that will promote both social and physical health.
But what initiatives are actually effective in meeting patients’ social needs? Which specific projects scale easily and make a noticeable dent in patient health?
At this point, the healthcare industry doesn’t quite know, according to Garth Graham, president of the Aetna Foundation, which hosts programming around the SDOH.
“Nationally, there's awareness that we need to tackle social determinants of health, but the best strategy to do that has not been uniformly identified,” Graham explained in a previous interview. “It's not always clear whether the best thing to do is tackling food insecurity, whether you tackle housing, whether you tackle transportation, or whether you look at issues around education and job security.”
Some industry leaders are beginning to investigate this question by looking at evidence-based community health projects. A partnership between the Aetna Foundation and the National Quality Forum will aggregate examples of successful social programming. The two healthcare leaders plan to build a guidebook of sorts for other organizations looking to begin the same types of projects.
The American Hospital Association (AHA) is also seeking applications for its 2019 Innovation Challenges to address the SDOH using health IT.
But certain models have already begun to emerge as effective, or at least feasible and scalable. As more healthcare organizations forge community relationships, they are building programs that look at food security, affordable housing access, and medical transportation barriers.
Although SDOH projects must be community-specific and informed by a comprehensive community health needs assessment (CHNA), these social issues have emerged as common and as ones with viable solutions.
Working to address food security
Food security is one of the top common social determinants of health. Patient populations across the country live in food deserts in which it is difficult to obtain food either due to geographic or financial barriers. In other populations, finances limit patient access to nutritious food.
In either case, food insecurity can lead to chronic disease, most prominently diabetes.
While some hospitals and physician groups are prescribing patients affordable food options, some payers are putting those projects to scale and creating partnerships to connect entire populations with affordable food.
The Blue Cross Blue Shield Institute (BCBS Institute) recently announced a partnership with the Health Care Service Corporation (HCSC) and foodQ to connect more patients with nutritious food.
“Food deserts are one of the key social determinants of health impacting millions of Americans,” said Manika Turnbull, vice president and community health and economic impact officer, HCSC. “With this program we are meeting people where they live to provide access, affordable pricing and education that can influence healthy behaviors, reduce health disparities and improve their quality of life.”
Using foodQ services, BCBS Institute and HCSC will deliver nutritious meals to families living in food deserts. Ideally, improving food security will reduce the likelihood of chronic illness and cut hospital and emergency department (ED) visits.
Individuals can check their eligibility for the program by entering their zip code onto a foodQ website. Once verified, participants can enter their payment information, select their meal needs, and select the date on which the meals will be delivered.
This will provide peace of mind for providers, who often treat patients experiencing food insecurity but who have limited avenues to address the issue, said BCBS Institute’s president Trent Haywood, MD.
“We know a ZIP code is just as important as a genetic code in determining a person’s health – impacting medical needs and access to care,” Haywood explained. “As a physician, I know I can easily write a prescription, but what I don’t know is how am I going to make sure patients have access to healthy meals they can afford and want to eat. With the alarming rates of obesity and diabetes in our country, we need a different approach to supporting healthy living, and this pilot program can help remove the barriers that keep people from accessing healthy, affordable and nutritious foods.”
Creating affordable housing
Healthcare organizations are also working to promote access to affordable housing. These are hyper-regional efforts, with hospitals and health systems working to create affordable housing options that are close to their care sites.
Connecting patients with affordable housing is a critical health needs, according to Steven Brown, the University of Illinois Health & Hospitals Director of Preventative Emergency Medicine.
“We have come to view homelessness as a dangerous health condition, not only a social condition, because of the extreme conditions of living on the street,” Brown said in a past interview.
“If you begin to wear a lens of thinking that it's a dangerous health condition, then it just makes sense that hospitals would want to go beyond what they typically do, beyond delivering excellent medical care, and really move into a population health space,” Brown asserted.
At the California-based Kaiser Permanente, creating affordable housing options was key for improving not only health, but other patient social needs.
The health system announced a partnership at the start of 2019 targeted at creating affordable housing options for patients in the Bay Area.
Kaiser engaged regional partners, including Enterprise Community Partners (Enterprise) and East Bay Asian Local Development Corporation (EBALDC) to create sustainable and affordable housing options for underserved individuals in the Bay Area.
Kaiser Permanente and Enterprise invested in a 41-unit housing complex to keep it affordable. EBALDC is managing the building and making necessary updates. Additionally, Kaiser and Enterprise each promised matching $50 million donations to create a national loan fund for affordable housing in Kaiser’s care areas, including eight states and Washington DC.
“Housing security is a crucial health issue for vulnerable populations,” Kaiser CEO and chairman Bernard J. Tyson, said in a statement. “Access to affordable housing is a key component to Kaiser Permanente’s mission to improve the health of our members and the communities we serve and to advance the economic, social, and environmental conditions for health.”
Driving care access through medical transportation
Enabling better medical transportation is a key initiative for various industry stakeholders. Payers and providers alike are partnering with rideshare companies and non-emergency medical transportation (NEMT) providers to connect patients with their providers. These ride providers are also working to make a more workable healthcare interface themselves.
Improving patient care access through medical transportation was the impetus behind the BCBS Institute, which now focuses on numerous SDOH. At its start, the Institute used zip code data to target patients living in transportation deserts. BCBS Institute began its work with a Lyft partnership.
“Lyft is proud to partner with the Blue Cross Blue Shield Association to address the social determinants of health through the launch of their new Institute,” said Lyft Co-Founder and President John Zimmer. “The work we're doing with BCBSA is critical to our goal of reducing the transportation health care gap by 50 percent in the next two years—and a key part of our mission to improve people's lives with the world's best transportation.”
These rideshare companies, which have also created partnerships with hospitals, physician offices, and other healthcare organizations, have made a dent in medical transportation. Lyft’s 2019 Economic Impact Report revealed that it has connected 29 percent of all of its riders with a ride to a medical appointment.
And although it has not publicly released such information, similar trends have likely emerged with rideshare competitor Uber, which has its own healthcare offshoot, Uber Health.
Many of these efforts are in their infancy, with most organizations just integrating the SDOH into their care management strategies. More time will be needed to determine the widescale social impact of housing security, food access, and transportation programs.