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Are Providers Responsible for the Social Determinants of Health?

Although most providers agree social determinants of health are important for patient wellness, they do not believe addressing these factors is their responsibility.

social determinants of health

Source: Thinkstock

By Sara Heath

- Medical professionals and other healthcare industry stakeholders need to develop strategies that allow clinicians to address the social determinants of health without adding to administrative burden and provider burnout, according to a recent report from Leavitt Partners.

The whitepaper, informed by a survey of 621 clinicians across the country, contended that the increased focus on the social determinants of health is a natural progression in an industry that has shifted focus from volume to value.

“The health impacts of the environments in which we live— our social determinants of health—are well documented,” the report authors noted. “Clinical care accounts for only about 20 percent of health, while behaviors, physical environment, and social and economic factors determine the rest. The transition to value-based care increasingly requires the clinical setting to address these social determinants of health (SDOH); however, how to tackle these systemic social challenges is less apparent.”

The report emphasized that most clinicians agree that addressing the SDOH is important to overall patient health.

Seventy-five percent say information about price and health insurance will lead to better outcomes. Sixty-six percent agreed that offering transportation to patients is important, while 54 said efforts to increase patient annual income would improve patient health.

READ MORE: Food Security, Social Determinants of Health Lower Hospital Use

Forty-eight and 45 percent of respondents said food and housing security would support better patient health, respectively.

There was some variation between providers who were more or less receptive to integrating social determinants of health into patient care, the report noted.

Clinicians who have been practicing for less than 20 years a more likely to see the value in addressing SDOH, the report noted.

Additionally, physicians with more than 30 percent of their patient panels on Medicaid are significantly more likely to see the link between housing security, income, and transportation in achieving patient wellness.

However, providers who engage in many value-based payment models are no more likely to recognize the SDOH than providers who engage in more fee-for-service models.

READ MORE: Programs Targeting Social Determinants of Health Improve Wellness

“Under value-based models, physicians ideally have more flexibility to transform their practices and are further incentivized to consider their patients’ social situations that substantially contribute to health and well-being,” the researchers explained.

“Because of this context we would have expected physicians in value-based payment models to be more likely to show interest in addressing patients’ social needs, given the view that the success of these models to both improve health care and lower costs may hinge on the health care system’s ability to help patients with these needs,” the researchers continued.

The researchers posited that providers in value-based care payment models may still be determining how to integrate SDOH into their clinical care.

Even though most clinicians agree that SDOH are important to patient health, most of them say it is not their clinical responsibility to address these social issues.

For example, 66 percent of providers recognize a proposed link between transportation access and patient health. However, 69 percent of providers said it was neither their nor an insurer’s responsibility to arrange transportation access.

READ MORE: Using Social Determinants of Health in Patient-Centered Care

For the few providers who do think they should be addressing the SDOH, very few of them believe they have the resources to do so. Some agree that community health partnerships are essential, while others believe non-clinical or administrative staff can be in charge of social health outreach.

Clinician respondents also cited numerous reasons why they cannot address the SDOH, including:

  • Physician offices cannot obtain affordable options to address SDOH
  • Other sources exist for addressing SDOH
  • Not enough time
  • Limited compensation for these services

Additionally, traditional fee-for-service payment models do not incentivize providers who address the social determinants of health. Although value-based care models are indeed becoming more prevalent, fee-for-service payments remain a barrier to better social health.

“The fee-for-service system constrains physicians’ capacities to consider and aid with SDOH because there is insuf­ficient time in an appointment,” the researchers reported. “Fee-for-service creates perverse incentives because sicker patients are a better source of revenue and addressing the social determinants may reduce patients’ utilization and physician revenue under the fee-for-service model.”

Questions about provider burnout under fee-for-service models also limits efforts to address the SDOH.

“New expectations for physicians’ roles in identifying SDOH come at a time of intense change and concerns about physician burnout,” the report noted. “Some argue that the current health care climate provides physicians with the support and funding to justify investments in SDOH. Meanwhile, others assert that now is not the right time for physicians to address SDOH because the transition to value introduces enough new changes to which physicians must become accustomed.”

As a result, medical professionals must identify strategies to address the social determinants of health that do not add to clinician burden, engage policymakers and employers as key SDOH stakeholders, and continue the investment in public health.

“Physicians already struggle from burnout due to excessive administrative work,” the report authors asserted. “Solutions that consider SDOH patients must seek to reduce, rather than add to, the burden on providers. Moreover, calls for clinical practices to address patients’ SDOH must be matched by similar efforts from other sectors, such as employers, and an increased investment in public health and policies that improve community health.”

Some medical professionals are leveraging strategies to reduce administrative burden in other areas so there is more room for clinician work on the SDOH. Additionally, some providers are calling for the inclusion of care coordinators and case workers on all patient care teams to address SDOH.

Others are putting the pressure on employers to address SDOH, as those social factors also have an impact on an employee’s ability to do quality work.

“Employers also have incentives to help keep their employees and even the broader community healthy,” the report pointed out. “Unhealthy food, unstable housing, and unreliable transportation all contribute to both instability in employees’ lives and potentially to illness, which may lead to lower levels of productivity and missed workdays.”

These efforts will also require a cultural change around public health. Public health initiatives will ease some of the burden placed upon physicians and employers.

“Public health funding and infrastructure are needed at the local level to support clinical efforts to address patients’ SDOH,” the report authors noted. “Policy makers can signi­ficantly assist the efforts of clinicians, employers, and public health of­ficials by helping to create a healthy context for people’s lives, including adding more sidewalks and walkways to communities, promoting healthier food choices in communities, and preserving more green space for outdoor recreation and exercise.”

The social determinants of health will likely continue as a key imperative in the healthcare space, especially as industry leaders continue to call for value-based care and overall patient wellness.

“Success in value-based payment models will increasingly compel the health care system to pay attention to the social factors that influence patients’ health and health care needs,” the report concluded. “Strategies aimed to address SDOH in the clinical setting must focus on ways to remove rather than add to the burden on physicians and that engage other stakeholders including employers and the public health community.”

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