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Few Docs Discuss Social Determinants of Health with Patients

Sixty percent of patients said their providers are not discussing the social determinants of health with them, despite industry calls to the contrary.

social determinants of health

Source: Thinkstock

By Sara Heath

- Sixty-eight percent of patients have experienced at least one of the social determinants of health (SDOH), but very few are talking to their doctors about it, according to a recent report from Waystar.

The SDOH are the various lifestyle factors that impact a patient’s ability to engage with the healthcare industry and achieve good health. These factors can include any number of things, but for the purposes of the survey, experts defined SDOH at financial security, food security, social isolation, housing security, addiction, access to transportation, and patient health literacy.

Most of the over 500 survey respondents said they experience some sort of SDOH factor, the report revealed, including even the healthiest populations. The most common social factors patients cited were financial insecurity and social isolation issues.

Those stressors were consistent across both government and private insurance beneficiaries, although there were some differences in the number of patients with an SDOH issue.

Government payer pools, such as Medicare or Medicaid, have the highest proportion of patients experience an SDOH, with 33 percent of respondents reporting such. For commercial payers, only 21 percent of patients reported an SDOH burden.

Despite the prevalence of the SDOH, 60 percent of respondents said they have never discussed these issues with their providers. Only 22 percent said they have explicitly discussed SDOH with their providers, revealing some gray areas for patient-provider communication.

The survey also found that providers who attempt to discuss SDOH with their patients may not be approaching the conversation in an effective way. Most conversations about SDOH happen with patients who are least likely to be impacted by these factors or who are least likely to accept help in addressing these issues.

Forty-six percent of patients offered assistance with an SDOH stressor declined that help, the survey showed.

Nonetheless, these patients still fare better than those having SDOH conversations with insurance providers. Those discussing SDOH with providers are 2.5 times more likely to accept help for an SDOH from a provider than an insurance representative.

Addressing the social determinants of health is becoming a bigger and bigger healthcare issues, the survey revealed. Patients with SDOH risk are 20 times more likely than those without risk to miss a medical appointment.

This issue, combined with the other health issues SDOH can pose, highlight the importance of discussing SDOH with patients and developing programming to address those challenges.

Separate research has suggested that despite the noted importance of SDOH in healthcare, few doctors are successfully discussing or addressing social issues with patients.

A 2018 report from Leavitt Partners showed that most providers believe efforts to discuss and address SDOH are important to improving the healthcare industry.

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 percent said efforts to increase patient annual income would improve patient health. Forty-eight and 45 percent of respondents said food and housing security would support better patient health, respectively.

However, not all doctors agree that it is part of their jobs to discuss SDOH with their patients. For example, 66 percent of physicians said they saw a link between transportation access and health. However, 69 percent of them said it was neither their nor a payer’s responsibility to arrange for that transportation.

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

Although provider efforts to address SDOH still leave something to be desired, authors of the Leavitt Partners paper stated that public health programs are set to improve over time. After all, value-based care models and other industry changes will make it so providers need to address these issues to achieve success.

“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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