SOCIAL DETERMINANTS: THE EMERGING SUPERHEROES OF POPULATION HEALTH MANAGEMENT

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By Abhinav Shashank

What causes two patients of the same age and with the same disease but from different regions to respond differently to a certain treatment? Even if these two patients appeared similar on paper, their lifestyles are very likely to differ- socioeconomic status, gender, race, ethnicity, family structure, and education.

Is SDOH a promise for a better future, or is it just another hype?

Success in the value-based care environment cannot be achieved based solely on clinical insights. According to one study, clinical care accounts for only 20% of the health outcomes of patients, while health behaviors, social and economic factors, and physical environment combined add up to influence the remaining 80% of health outcomes.

Social determinants matter because they can affect the health of the population residing in a particular region for better or for worse. Trying to improve population health armed with only clinical data and not the non-clinical factors, is like investing in a project which cannot generate positive returns.

Although multiple pieces of research demonstrate that social determinants may substantially contribute to a person’s health status and well-being, the major problems are these:

  • How do we address these complex challenges?
  • Who is the best-positioned stakeholder to do so in a clinical environment?

What is the right way to address these social determinants?

The Centers for Disease Control and Prevention (CDC) has defined an algorithm to estimate the Social Vulnerability Index (SVI) for every census-tract in the US. However, this algorithm is based on a simple summation of the percentile ranks for all SDOHs, which results in an over-estimation of social vulnerability in cases of high positive correlation between multiple SDOHs.

Working with SDOH data requires a more drilled-down approach and the use of predictive analytics to accurately measure the at-risk population and to advance preventive care methods in an ecosystem.

The right approach is to start from a state-level analysis and drill down to the zip code-level. The effects of social determinants vary in accordance with a very small region. There is a high possibility that all the zip codes in a county will have different susceptibility to a particular social determinant.

What new ways can a revolutionary approach to SDOH open for healthcare?

Every social determinant affects the region in its own way and corresponding preventive actions need to be taken in order to overcome the adverse health outcomes of the citizens of that region. For instance, community resources and data needs to be integrated into the care coordination processes to make proper interventions. When providers are able to completely understand the effects of non-clinical factors, they can provide much better care to their patients.

The analysis of social determinants can be applied for multiple use cases such as:

  • Identifying the role of behavioral health, social workers and health coaches
  • Increasing the efficiency of the care coordination team
  • Forging better partnerships with community resources and social improvement funding agencies, and many more.

The road ahead

Though providers have recognized that social factors significantly influence their patients’ health, they are often unaware of their patients’ social vulnerabilities and are unable to accept responsibility for managing these issues or providing support to their patients outside of the clinical realm. We are stepping into the age of predicting and preventing diseases instead of curing them. That was the traditional approach. With non-clinical data and resources such as SDOH, we can change the future of US healthcare. All we need is the will to right these wrongs.

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