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By Monica E. Oss

Discussion about how social factors affect health care costs continues to amplify—and the numbers are pretty clear. Low-income consumers—who often have more negative social determinants of health—are higher utilizers of acute care services; account for the majority of both preventable hospitalizations and readmissions; have higher rates of smoking and obesity; and have shorter life spans (see Social Determinants, Health Care Outcomes, & Health Care Costs – A Look At The Numbers).

As Arthur C. Evans Jr., Ph.D., then commissioner of Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services (DBHIDS), explained in his keynote address, Tending To The Social Determinants Of Health – Or Not, at The 2015 OPEN MINDS Performance Management Institute, health status is affected by biology, environment, and lifestyle factors, as well as health care. And as health plans and provider organizations are increasingly responsible for value and consumer outcomes, the interest in how to address social determinants has increased.

So it was with great interest that I recently read a National Academy of Medicine discussion paper, Social Determinants Of Health 101 For Health Care: Five Plus Five, that presents “what we know and what we need to learn about SDoH to achieve the national quality strategy of better care, healthy people/healthy communities, and affordable care.”

The five things the paper claims “we know” as a field may sound familiar:

  1. As a determinant of health, medical care is insufficient for ensuring better health outcomes – “Health care” as we know it is only 10% to 20% of the contributors to consumer health, and the rest are those SDoH that affect whole consumer populations.
  2. SDoH are influenced by policies and programs, and associated with better health outcomes – Consumer behavior, such as smoking, can be influenced more effectively through programs and policies that make the habit more expensive, as compared to solely relying on health care oriented service models.
  3. New payment models are prompting interest in the SDoH – As outcomes become more common than process measures, alternative payment models, accountable care models, and Medicare Shared Savings, outcomes affected by SDoH will gain more attention.
  4. Frameworks for integrating SDoH are emerging – Integrating SDoH into primary care and capturing SDoH domains in electronic health records (EHRs) has begun, providing the necessary data for continued population management.
  5. Experiments are occurring at the local and federal level – At the state level, innovation models are exploring connections among health care, social services, and SDoH; at the national level, the Centers for Medicare & Medicaid Services (CMS) accountable health communities (ACH) are currently testing how to match SDoH needs with a population.

It was the second list—the things “we need to know” about SDoH—that I thought was truly valuable to executive teams trying to get a grasp on the strategies that will help their service models in the coming years.

  1. How do we prioritize SDoH for individual consumers and for communities? – Do you have “proven or testable interventions”, and a return-on-investment? This strategic question goes far beyond just SDoH, and should be the driving force for any new service line development.
  2. How do we intervene without medicalizing SDoH? – The instinct of many health care organizations may be to apply the old “medical” and/or “behavioral” models to SDoH, instead of innovating new and uniquely applicable, cost-effective, and community-based services.
  3. What (new) data are needed? – No matter your service line, whether that’s primary care, behavioral health, or SDoH, “what data do we need?” might be the mantra of the decade. Identifying the correct data is fundamental to any health care or social services approach to services.
  4. How do we build multisector partnerships? – Collaboration has been on the drawing board for many health and human service organizations for some time, and to expand services into the community for SDoH, provider organizations will need to partner with more than just other health care organizations.
  5. What else? – An example of “outside the box” thinking for many health care executive teams is to find a way to focus on consumer and community assets instead of just deficits (what is “wrong” with the consumer and the community). This will be key to building collaborations.

There is work emerging in this area – check out Social Services Paid By Health Plans? and Health Care’s Value-Based Reimbursement Models Creating A New Role For Social Services; as well as these three case studies:

  1. Making The Health Care Social Service Link: The Wellcare Medicaid Healthy Rewards Program Case Study
  2. Making The Health Care Social Service Link: The CareSource Life Services Case Study
  3. Making The Health Care Social Service Link: The Optum MyWellnessPath Case Study

And for more on the topic, check out these resources in our OPEN MINDS Industry Library:

  1. Two-Thirds Of Alzheimer’s Disease Cases Attributed To Nine Preventable Risk Factors
  2. Lifestyle Changes Are Effective For Preventing Dementia
  3. Stress & Health (& Health Care Spending)
  4. Assessing (& Addressing) Consumers’ Social Support Needs
  5. Data Set Directory Of Social Determinants Of Health At The Local Level
  6. Social Determinants Of Equity & Social Determinants Of Health
  7. CMS Develops 10-Item Screening Tool Focused On Social Determinants
  8. Uberizing Health Care Transportation
  9. Social Services As Mental Health ‘Prescription’
  10. Population Health Management & Social Determinants – First, Define ‘Community’

For more, join Michael Griffin, Chief Executive Officer, Daughters of Charity for his plenary address, “Sustainability In A Competitive Market: The Daughters of Charity Services Story,” on June 5, 2018 at The 2018 OPEN MINDS Strategy & Innovation Institute.


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