- Healthcare organizations are tapping into the social determinants of health to improve patient-centered, value-based care, but do not yet have a consistent and targeted approach, according to a new Deloitte report.
The report, which included the results of a survey of nearly 300 hospitals across the country, showed that healthcare organizations believe health is determined by more than clinical encounters and diseases.
“Health care stakeholders have long recognized that factors outside the health care system—the social determinants of health—influence an individual’s health and well-being,” the report said.
On average, 80 percent of a patient’s health is determined by external influences such as socioeconomic status, living and work environment, race, educational attainment, and other social factors, according to Deloitte.
As a result, 80 percent of hospital leaders support organization efforts to account for the social determinants of health.
Eighty-eight percent of hospitals are taking action on the social determinants of health by screening patients for social needs – issues ranging from housing assistance to subsidized lunches for school children. Twenty-six percent of that screening is occasional, compared to 62 percent of hospitals that consistently screen patients.
Although more hospitals are consistently screening patients, Deloitte suggested that more organizations should regularly conduct these screens.
Additionally, hospitals should move away from targeted social screening. Ninety percent of respondents said they screen all inpatients, and 83 percent said they screen their high-utilizer patient populations. Only 69 percent of hospitals said they screen broad patient populations, a number Deloitte said should ideally increase over time.
The push for more value-based care and risk-based payment models had driven hospital attention toward the social determinants of health, the survey found. Hospitals that are further along in the shift toward value-based healthcare also have more investments in tracking and acting upon the social determinants of health, the report explains.
Hospital investments in social health vary because progress toward value-based care currently varies, the report noted.
Seventy-two percent of hospitals said that they do not have a dedicated fund for their unique patient populations. For the financial resources they do have, most hospitals said they tap into pools of community, state, federal, and private funds to support the social determinants of health.
While investments do vary, the report noted that they are not correlated with a hospital’s primary patient population. Hospitals that serve needier patients – non-profit hospitals and disproportionate share hospitals (DSHs) – do not necessarily have larger social health investments than other hospital types.
Most hospitals are also struggling to adequately measure the efficacy of social health outreach, the report said.
Although nearly all respondents said tracking outcomes – cost, clinical, and patient experience – is an important goal for social health, about 40 percent of respondents said they have no capability for tracking outcomes. Thirty-five percent of hospitals said they measure cost outcomes for their social determinant activities.
As value-based care moves forward, so will the imperative for hospitals to track patient clinical and social needs. Most hospitals said activities for the social determinants of health are a moral obligation and they are hopeful that value-based care will continue to push for these activities.
However, hospitals will need the right skillset and tools to successfully act on social health.
"The research really highlights the gap between desire and ability in this industry right now,” said report co-author and Deloitte Principal Josh Lee. “It's striking to see how widely health care leaders embrace the mission of addressing social needs, with an almost palpable frustration around how best to take action.”
Deloitte concluded the report by offering recommendations for hospitals looking to drive their social health activities.
First, hospitals must create a clear definition and set of priorities for the social determinants of health. Hospitals must also consolidate their resources, reduce duplicative social efforts, and create strategies to track clinical and cost outcomes.
From there, hospitals must identify strategies that have proven successful and practice them at a larger scale. Hospitals can fund these projects by sharing success stories to drive investor buy-in.
Ultimately, hospitals hoping to continue their efforts in the social determinants of health should look to advance value-based care efforts. Deloitte experts explained that value-based care and social health are intrinsically linked, and investing in one will help drive the other.
"I think hospitals and other providers see clearly the connection between social determinants and health care. They see it every day,” said Deloitte Managing Director Sarah Thomas.
“And from this study we see that they are taking steps to do something to help their patients connect to programs that can address their needs," added Thomas, who is also the leader of the Deloitte Center for Health Solutions. "What we still need, though, is a better understanding of what programs work best and for which patients."