Getting Started On Social Determinants of Health

By Bradley Hunter, research director of population health, KLAS Research.

Bradley Hunter

Over the last couple of years, social determinants of health (SDoH) have become increasingly important. I recently attended the 2019 Nineteenth Population Health Colloquium, and based on what I heard there, SDoH are definitely in vogue. And little wonder — some studies have shown that one’s zip code is a better predictor of health than one’s genetic code.

The reality is that very few people are doing great things with SDoH at this point. A lot of vendors and providers are thinking and talking about SDoH, but many of them don’t yet understand which social determinants are relevant or what to do about them. While the area is too new to boast a list of best practices, an introduction and discussion to the topic might be helpful for those considering a foray into SDoH.

What are SDoH?

The Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, defines SDoH as “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”

If you think that sounds broad, you’re absolutely right. These determinants cover everything from how clean your water is to what your friends are like. The factors are innumerable. Stakeholders estimate that only 20 percent of one’s health is based on clinical care received from healthcare providers, with another 20 percent to 30 percent based on genetics and at least 50 percent based on SDoH.

With those assessments in mind, it seems unfair that almost everything related to health is pinned on provider organizations. The healthcare system cannot be the only player. We say that it takes a village to raise a child, and it would take a village to adequately deal with social determinants.

But those working in healthcare can’t just wait for villages to get involved. As the market continues to shift toward value-based reimbursement, health systems, payers, and vendors will be expected to incorporate SDoH into their tools and patient care. A few principles might help these stakeholders to get started.

The beginnings of a SDoH strategy

An organization’s first step in incorporating SDoH into their strategy should be to decide which data is the most important. For example, it probably wouldn’t help a physician to know which university a diabetic patient attended, but it could help a lot to know that the patient orders takeout almost daily because he doesn’t have a car and isn’t within walking distance of a grocery store with healthy options. These are aspects that, one day, may fall under the banner of SDoH.

Once an organization knows which data elements they want, they can determine how to get it. Unfortunately, the regional nature of SDoH data makes creating an excellent database very difficult. This is why we need vendors to keep SDoH on their minds. Providers need their vendor partners to incorporate SDoH data into their EMRs, population health tools, and other platforms. Healthcare organizations can also gather data by conducting assessments on-site or at patients’ homes.

Once providers have the right data in place, they can incorporate it into their patient management. The case managers and care coordinators will be critical. Ideally, they will be empowered by comprehensive value-based contracts to create a healthcare path for each individual patient.

The unfortunate reality is that care coordinators can give major attention to only a small subset of the population. SDoH data can help care coordinators focus on the most vulnerable patients. For example, a care coordinator, upon learning that a patient has inadequate housing, can initiate a potentially life-saving intervention. These interventions may be incredibly varied in nature and require some creativity on the part of the care team, but they can have a dramatic impact on a patient’s health.

Learning what works

Some organizations are getting very creative with SDoH. For example, some health systems are beginning to write food orders instead of prescriptions. Others are reaching out to social, community, and faith-based organizations.

Various non-healthcare companies are also getting involved. Some people may be surprised to learn that Lyft and Uber had booths at HIMSS, but paying for a patient to get a ride to and from her appointment is actually cheaper than that patient missing an appointment and coming to the ER later.

There may be as many unique ways to handle SDoH as there are unique health systems. Organizations will have to consider their options, gather the data, and create the strategy that will work best for them. The most important part of implementing the new factor of SDoH may be old-fashioned ingenuity.

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