PODCAST: “Social Determinants of Health”

Webinar Recap of “Social Determinants of Health: Turning Potential into Actual Value Webinar Recap of “Social Determinants of Health: Turning Potential into Actual Value”

A brief recap of the webinar: “Social Determinants of Health: Turning Potential into Actual Value,” sponsored by LexisNexis Health Care, with Erin Benson, Director Market Planning and Rich Morino, Director, Strategic Solutions.

This recap includes discussion of 5 categories of SDOH.

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2 Responses

  1. Social determinants of health

    Social determinants of health include economic stability, education, health and healthcare, neighborhood and built environment, and social and community context, according to Healthy People 2020, which provides 10-year national objectives for improving Americans’ health. “These are the conditions in which people are born, grow, live, work, and age, as well as the circumstances that impact their health,” says Lori Tremmel Freeman, MBA, CEO, National Association of County and City Health Officials, which advocates for local health departments. “Social determinants of health undergird many current healthcare challenges, including obesity, heart disease, diabetes, and depression.”

    While genetics plays a role in an individual’s overall health, most health outcomes are the result of circumstances outside the healthcare system. “The conditions in which someone lives, whether they have transportation to a clinic when needed, their support network, and other factors beyond the doctor’s office are as important to an individual’s overall health and well-being as being treated for an illness,” says Joseph Valenti, MD, board member, The Physicians Foundation, an organization that seeks to help physicians deliver high-quality care. “As the healthcare system effectively addresses these issues, the overall price of healthcare in the United States will decrease and people will generally be healthier.”

    Some states, insurers, and hospitals are already factoring social determinants into healthcare by doing things like ensuring patients have adequate housing and access to needed resources and programs.

    Freeman says more attention to social determinants would provide a more balanced approach to health.

    From a public health perspective, she says healthcare can be categorized at three levels:

    1. Primary, focused on disease prevention;
    2. Secondary, treating disease in the early stages; or
    3. Tertiary, treating the effects of a disease or illness.

    Considering diabetes as an example, primary care would include a focus on healthy lifestyle, secondary care would involve monitoring of blood levels and medication, and tertiary care could include amputation.

    Primary, secondary, and tertiary care can be targeted at the individual, interpersonal, organizational, community, or public policy level, Freeman says. Naloxone, a medication designed to rapidly reverse opioid overdose, for example, is tertiary care at an individual level. On the other hand, given that unemployment is thought to contribute to patterns of opioid use, a strategy of increasing job opportunities becomes primary care at a community level. By focusing on the social determinants, organizations can better address population health problems.

    Social determinants of health could impact how the healthcare industry conducts business. Instead of concentrating on tertiary care for patient populations only, healthcare could participate more in community health, Freeman says. Eventually, as social determinants of health become a greater part of the healthcare portfolio, tertiary care spending would decrease while quality of life would increase for affected communities.

    In many places, this has already begun, as hospitals and health insurers work with local health departments around community health concerns, she says. By law, providing community benefit has been central to the tax-exempt status of nonprofit hospitals. The ACA’s explicit requirement for nonprofit hospitals to consider input from those with public health expertise in the development of hospital community health needs assessment and implementation strategies has increased local collaborations around social determinants of health.



  2. WHO

    The World Health Organization has defined the Social Determinants of Health (SDOH) as, “The conditions in which people are born, live, work, and age.” The WHO goes on to say that “these circumstances are shaped by the distribution of money, power, and resources at global, national, and local, levels.” Social determinants are a cause of a number of major health inequities including heart disease, obesity, diabetes, drug addiction, alcoholism, and a variety of mental health issues. The growing inequalities of health and wellness in many communities in the midst of economic growth and concentrated wealth has helped to direct attention to SDOH.

    Further, the advent of value-based contracting and population health programs has required clinicians like me to take a more holistic view of the circumstances in which our patients work and live.

    There is a long list of social determinants of health including transportation availability, safe housing, physical environment, racial segregation, access to safe drinking water, food insecurity, that impact community health. Recent research has shown social determinants, in fact, have a higher impact on population health than healthcare services; and that states that allocate more resources to social services than to medical spending have improved health outcomes over states that do not. Data availability, of course can be challenging. But the rapidly emerging field of data analytics has opened the door for companies such as LexisNexis Health Care which gathers SDOH data from public sources to help predict which patients may be facing serious health issues, and the National Association of Community Health Centers which has developed a risk-based SDOH tool for interviewing patients.

    Previously viewed as simply beyond the scope of provider systems, SDOH have historically been overlooked in clinical practice. However, the move from volume to value-based contracting has opened the eyes of providers to the financial impact of SDOH and has prompted an increasing number of provider systems to address SDOH as an element of their population health strategy. A new set of SDOH standards identified by the Institute of Medicine in 2012 identified 12 different SDOH measures that are only recently becoming used in clinical practice. SDOH initiatives focus on community partnerships that may offer food, temporary housing, and transportation. Organizations such as Montefiore Health System in the Bronx have reported a well-publicized “300% ROI” on their community housing program which has reportedly reduced ER visits and readmissions among high risk and chronically ill patients. Other providers are partnering with community organizations and are using data to identify frequent users of ER services and link them to primary care providers.

    The good news is that the move toward population health management will fuel local SDOH initiatives that can generate a ROI in a value-based reimbursement environment. But it should be clear that these SDOH efforts are not focused on improving the underlying social and economic conditions of these communities to foster improved health for all—they are primarily about ameliorating the social service needs of individual patients, and by doing so securing better outcomes for the provider’s value-based contracts. Our own experience is that the most successful population health program will have an SDOH focus as part its efforts. These investments in social and community services are essential, especially for any providers dealing with high risk dual eligible and Medicaid patients.

    As we start to normalize the tracking of SDOH metrics, the next question will be should we hold providers accountable for performance on these metrics-as we do now for quality? Based on a decidedly unscientific “biopsy” of medical institution hallway conversations, being accountable for social factors makes providers very nervous. Nevertheless, holding provider systems accountable for performance in this area is a potentially powerful tool, even more so if in doing good, provider systems can also do well.

    David Fairchild, MD, MPH
    Director – BDC Advisors
    via Ann Miller RN MHA


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