- The social determinants of health are an increasingly important concept in value-based healthcare. Defined as the external factors that affect patient health, the social determinants of health can influence whether a patient develops a chronic illness, can access medical care, or attain wellness.
The World Health Organization has described the social determinants of health as “the conditions in which people are born, grow, live, work, and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.”
Specific social determinants of health can include socioeconomic factors; race, gender, or sexual orientation; housing; language and culture proficiency; health literacy and general educational attainment; access to transportation; food security; and other social issues.
The social determinants of health are also tied to health equity and health disparities. When a social factor goes unaddressed – poor housing, for example – it could have a downstream effect on patient health, such as developing respiratory issues. Patients living in areas with high rates of unsuitable housing might develop respiratory issues at a higher rate, leading to a health disparity.
Healthcare professionals frequently cite the statistic that 80 percent of patient health is determined by social factors, and that a patient’s zip code is a better predictor of health than genetic code. Addressing these root causes can result in cost savings.
Not addressing social needs has resulted in higher costs, according to 2017 data from CMS. Hospitals that disproportionately treat patients with significant social risk factors faced higher penalties in value-based reimbursement programs.
As healthcare organizations adopt value-based reimbursement models, it will be critical that they conduct patient outreach. High-needs patients only account for five percent of the patient population; however, these patients accrue 50 percent of total healthcare costs.
During the days of fee-for-service care, payment models did not provide incentives for organizations to address the social determinants of health. Whether or not a provider wanted to care for social health needs, it did not make financial or logistical sense to do so.
Now, the incentives and penalties faced in value-based care models are pushing healthcare organizations to address the social causes of patient health.
Addressing social health requires a patient engagement rework
Healthcare professionals need to overhaul their current patient engagement efforts to overcome social factors and barriers. In-office patient engagement techniques are not enough anymore; healthcare providers must also address the health factors that expand outside the four walls of the hospital.
“Over the years, efforts to eliminate disparities and achieve health equity have focused primarily on diseases or illnesses and on health care services,” says Healthy People 2020, a government-funded organization within the Office of Disease Prevention and Health Promotion. “However, the absence of disease does not automatically equate to good health.”
Addressing the downstream sources of a patient’s condition is key to improving overall population health, Healthy People 2020 contends.
In the diabetes example, healthcare professionals and community partners should ask themselves if patients have enough access to healthy food, or if they have proper diet education. Can the patient afford nutritious meals? If she is a child, does her school provide her with a good lunch, or are lunches filled with junk food?
The answers to those questions might reveal a health need. From there, healthcare organizations can increase their efforts to tend to community health, forge community partnerships, and overcome social health barriers.
How are healthcare organizations addressing the social determinants of health?
Healthcare providers, including both hospitals and healthcare payers, have begun work on addressing the social determinants of health.
On the hospital level, many organizations connect with community partners to overcome social needs. This outreach usually begins with recognizing some sort of health disparity or community shortfall.
Organizations can identify specific needs among their patient populations using community health needs assessments, which are an Affordable Care Act requirement for non-profit hospitals.
CHNAs help hospitals determine which social factors are driving health disparities and health inequity within the individual community. The assessment also helps hospitals determine which community partners have the necessary resources to address the social determinants of health.
The AHA detailed the following steps to creating a community health partnership in a 2017 resource:
- Identify partners and their assets
- Host community collaborative meetings
- Define roles and responsibilities in a collaborative
- Address common goals in a collaborative
- Create an action plan
- Measure partnership effectiveness
- Overcome obstacles
- Celebrate progress
Healthcare organizations that follow these steps ensure that they are creating a scalable plan for community outreach. Creating a common ground between the hospital and community partners will help drive a more permanent change for patients, according to Carol Friesen, MPH, FHFMA.
Friesen is the VP of Health Systems Services at Bryan Health, a Nebraska-based health system that published a compendium of successful community health partnerships.
“The common theme we saw through all of the stories is a shared purpose between partners,” she pointed out. “They were invested in creating long-term solutions for the community, not just put a Band-Aid on it, but making a 20-year impact in the community.”
Community health partnerships usually stem out of a mutual need for help addressing the social determinants of health, Friesen said. Communities, governments, and hospitals are all strapped for cash and cannot address patient social needs on their own.
“As the scarcity of resources in communities occurs, a larger amount of collaboration is required to meet the needs of communities,” Friesen explained. “The scarcity of resources has had an unintended consequence which has been very positive. It fosters a lot of creative partnerships and collaborations.”
Healthcare organizations can also work internally to meet patient social needs. Accountable care organizations should consider restructuring their staffing to meet social needs. ACOs can expand the roles of existing staff or hire new workers to overcome the social determinants of health.
Care coordinators, healthcare social workers, and healthcare navigators may be useful in this endeavor. Healthcare navigators, who help complex patients navigate the industry and social structures defining patient health, have a 1:10 return on investment, according to data in JAMA Oncology.
The value-based healthcare landscape is not going away. Healthcare organizations are increasingly adopting these payment models and working to deliver the highest quality care at the most efficient cost.
While traditional patient engagement efforts – patient activation, self-management, and patient-provider communication – are essential for improving outcomes, those efforts will not be enough to deliver value-based care. Traditional patient engagement strategies must be fortified by initiatives tackling the social determinants of health.
In addressing these downstream causes for health disparities and high-cost medical conditions, healthcare organizations can create a healthier population with lower healthcare costs.