Depression, alcohol dependency, risk of suicide, childhood trauma — clinical professionals and provider organizations employ a variety of assessment tools and standardized questions to screen consumers for the drivers of poor health care. These screening tools help to identify issues, standardize treatment planning, and uncover issues that influence a consumer’s whole health. One area where we’ve recently seen a greater interest in screening tools and assessments is social determinants of health (SDH).
As health plans and provider organizations are increasingly focused on value and consumer outcomes, the interest in addressing social determinants has increased. But there is a long path between identifying the correlation between social determinants and health care costs and developing social service interventions with a clear return-on-investment (ROI) for payers and health plans. This is especially difficult because the field hasn’t traditionally had great mechanisms for identifying SDH. And while screening for social needs is not yet standard in clinical practice, the ability to effectively screen for SDH continues to evolve.
In 2017, in an attempt to create a more standardized screening process, researchers with the Centers for Medicare & Medicaid Services (CMS) developed a 10-item screening tool to identify health-related social needs. The tool focuses on five domains that can be addressed through community-based services: housing instability, food insecurity, transportation difficulties, utility assistance needs, and interpersonal safety. The tool was developed in coordination with the Accountable Health Communities model, a five-year program that will test delivery approaches for linking clinical and community services. The 32 organizations selected for participation in the program are utilizing the screening tool as a standardized resource (see CMS Develops 10-Item Screening Tool Focused On Social Determinants and CMS Accountable Health Communities Model Selects 32 Participants To Serve As Local Test ‘Hubs’).
Earlier this month, Boston Medical Center (BMC) announced it had implemented a SDH screener for primary care consumers in order to better identify and address their unmet social needs—the BMC THRIVE Screening and Referral Program; it is based on the BMC electronic health record (see Boston Medical Center Develops EHR Tool To Screen For Social Needs). Consumers complete the screener before an appointment, answering questions on housing, food insecurity, transportation, and employment, and the screener autogenerates ICD-10 codes that are added to the consumer’s medical record. Of those with a social need, the most prevalent concerns were employment (12%), food insecurity (11%), and problems affording medications (11%).
The Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) from the National Association of Community Health Centers (NACHC) continues to be a popular tool utilized by health care provider organization. PRAPARE’s evaluation tool asks social health questions in areas ranging from demographic data and housing status to social-emotional health and physical security (see About the PREPARE Assessment Tool). They also provide an implementation and action toolkit that is being used by providers nation-wide to gather data that will allow them to assess their patients’ social needs, so they can take measures to address them. And many other organizations are developing their own screening and assessment processes (see How 6 Organizations Developed Tools and Processes for Social Determinants of Health Screening in Primary Care).
Already, 80% of payers use some method to identify SDH (see Payers Approaches To Addressing Social Determinants Vary), which means that even if you aren’t contracting with health plans right now that are focused on assessing consumer’s social support, the chances of that requirement in the future are all but guaranteed. As health plans put a greater emphasis on social determinants of health in value-based arrangements, provider organizations will need to find new ways to address consumer’s social support needs. But before those needs can be addressed, organizations will need a standardized tool to assess what those needs are. There are already many existing screening tools to explore, the key will be building an infrastructure (including staff training, shifting workflows to make screening a standard practice, incorporating assessment tools into electronic health records, etc.) that can support a standardized approach to screening for social support needs.
For more information to get your team thinking about new programming integrating social services, check out these resources from the OPEN MINDS Circle Library:
- The Social Services Market: Over $331 Billion In Spending In FY2016
- Addressing Social Determinants-The Measurement Challenge
- Social Determinants Today, Social Determinants Tomorrow
- Social Determinants Of Health & Medical Homes
- Addressing The Social Determinants Of Health With Income Assistance
- Medicare’s Path To Incorporating Social Determinants Into Value-Based Payment
- Humana Foundation Dedicating $7 Million To Address Social Determinants Of Health
- Social Determinants Of Equity & Social Determinants Of Health
- Screening Humana Medicare Advantage Members For Social Determinants Of Health Reduced ‘Unhealthy Days’ By 2.7%
- Solera Health Raises $42 Million To Address Chronic Disease, Social Determinants Of Health And Addiction
And don’t miss The OPEN MINDS Management Best Practices Institute, where Bechara Choucair, M.D., Senior Vice President & Chief Community Health Officer, Kaiser Permanente will discuss their approach to managing social determinants of health in his opening keynote address, Mind, Body, Community: Kaiser Permanente’s Unique Approach.