- The social determinants of health (SDOH) may be commonly accepted as key to successful value-based care strategies, but the road to addressing those factors is less clear. With efforts to build community health programs in their nascency, healthcare organizations are left in the dark on which models are most effective.
But a new partnership between the Aetna Foundation and the National Quality Forum (NQF) aims to close that knowledge gap. By aggregating 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.
“Aetna Foundation has been working with the National Quality Forum for the last couple of months on really trying to identify the innovations happening out in the world around social determinants of health,” Aetna Foundation president Garth Graham said in an interview with PatientEngagementHIT.com.
“And one of the things that was identified is the need for more models and the need to identify more scalable examples that the field could use to help harmonize efforts and help folks get a better understanding for what works and doesn't work.”
Aetna Foundation and NQF have embarked on a nine-month initiative to identify innovation and scalable projects around the SDOH established in communities across the country and across the healthcare spectrum. Ideally, these programs will serve as models for other organizations hoping to create the same social impact.
“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. “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.”
But this project presents yet another challenge – how, exactly, does one measure the success of a social program?
Measuring community health success is different from testing a new clinical intervention, Graham acknowledged. In clinical medicine, providers know that a heart attack patient needs aspirin because of the numerous scientific studies that have looked at key physical indicators.
But understanding the effectiveness of an individual social program is different. Should researchers look at the number of patients reached? Clinical outcomes? Cost savings?
Ultimately, they must look at a community’s quality of life, Graham said.
“We do have some conceptual ideas of where the biggest impacts are, but we still need to look at the kinds of things that improve quality, quality of care and quality of life, and the kinds of things that may even potentially improve quantity of life, depending on the scenario,” Graham explained.
While Graham and the team at NQF have not yet looked at any specific data – the data collection period has only just begun – they do have some idea of what social interventions might emerge as successful models.
“There's some initial data out there that shows that things like identifying food insecurity may be one of those strategies that are measurable and clinically tied to a variety of other factors,” Graham said. “And food security has even been tied to adherence with medicine and things along those lines.”
Additionally, programs for identifying social need at the point of care will likely emerge as successful models, Graham predicted.
This initiative doesn’t come without its challenges, Graham acknowledged. Addressing the SDOH is a very community specific task, making efforts to build a guidance on the matter difficult.
But it’s those challenges that make this project necessary, he added.
While a guidance can’t unilaterally recommend a food security program to an individual community – what if that community would benefit more from an affordable housing project? – it can offer use cases for these different needs. NQF and Aetna Foundation’s project will give broad how-to’s that direct community leaders to different viable options for their constituents.
“Certainly, the types of things that look feasible are making sure that at least initially you understand the needs of your community,” Graham explained. “Even in a generic context, you can make that universally applicable to make sure that you're actually understanding the needs of the community.”
“One of those initial broad concepts starts with first understanding in depth the needs and wants of your communities, and then from the menu of intervention options – from education, housing, job security, to all those other factors – you can look at which one of these are some of the best tested methods to meet the needs of your particular community.”
Ultimately, it will be essential for healthcare professionals to know which interventions the evidence supports – once they have determined that transportation is an issue, what types of models are proven most effective?
That is where NQF and Aetna Foundation are working to make improvements, Graham stated.
At this point, most of the industry agrees that addressing the social determinants of health is essential, he said. The World Health Organization has long advocated for these types of community programs. And with the growth of value-based care models, which require clinicians to reflect on the wellness of a patient inside and outside of the clinic, social programming has become the mainstream.
Now, it will be incumbent upon industry leaders such as NQF and the Aetna Foundation to determine the best models for building social programs, Graham concluded.