The State of SDoH Progress Today: What’s Working—and What’s Next

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By Carol Murdock

The healthcare industry has made substantial progress in understanding the impact of Social Determinants of Health (SDoH) on medical outcomes, and we’re beginning to see that deeper understanding drive powerful action at the patient level. Yet even with positive strides in the right direction, we still face considerable challenges when it comes to consistent and sustainable care for large patient populations at risk. The biggest challenge? Making efforts scale.

The World Health Organization defines Social Determinants of Health (SDoH) as “the conditions in which people are born, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries.” 

At the patient level, social determinants such as household income, education, food security, access to transportation, physical and psychological behaviors, and social support can contribute to as much as 80% of a patient’s overall health. For example, frequent use of the ER has been linked to homelessness[1], diabetes related hospital admissions have been linked to food insecurity[2] and the risk of stroke and heart attack have been linked to social isolation[3]

The last few years have seen healthcare organizations activate partnership programs that work to mitigate SDoH factors such as access to transportation, food and other community resources. 

While we are seeing best practices emerge, SDoH programs also uncover unresolved challenges such as reimbursement and the ability to share data among partners. 

Best practices emerging in SDoH programming:

As healthcare organizations and business stakeholders continue creating, launching and measuring SDoH-focused initiatives, some core best practices appear consistent.  Pilots, partnerships and personalization are common keys to early success.

Pilots allow for low-risk testing, iteration and improvement.

Numerous small-scale pilots have been set up to test impact before risking the expense of a nationwide launch. The regional nature of these pilots keeps the focus on specific populations and allows the efforts to prove impact and stay relevant to what is happening on the ground in certain geographies and pockets of culture. For example, in 2018, Blue Cross and Blue Shield Association launched the BCBS Institute (BCBSI) in an effort to battle the “Zip Code Effect.” Leveraging partnerships with Lyft, CVS Health® and Walgreens®, the BCBSI “combines a social mission with business innovation to target barriers to health care that can be solved with technology and strategic alliances.” The program aims to shine a light on the transportation, pharmacy, and nutrition gaps in specific neighborhoods, carrying patient care beyond the walls of a clinical setting and into the realities that many communities face every day. 

Partnerships expand capabilities without additional investment.

Strategic partnerships are another common best practice. Tapping into existing resources expands and scales programs without the need to re-invent the costly, time consuming ‘wheels’ required to set these programs in motion. For example, CVS Health and its Aetna health insurance unit are collaborating with a “social care coordination platform” called Unite Us. The partnership gives Aetna and CVS network doctors access to social providers such as community organizations and nutritionists to which they don’t otherwise have access.

Personalization keeps the patient at the center of the program.

A guiding belief at Catasys, where I serve as chief commercial officer, is that successful outcomes require a whole-person treatment philosophy built on trust by addressing socioeconomic issues that may drive behavioral health conditions, managing integrated behavioral/medical care, coordinating with providers and building member skills for durable health outcomes. As SDoH initiatives gain support, it’s clear that nothing replaces the trust built via 1:1 interactions between patients, their care coaches and community coordinators. Why is this third element so critical? Understanding SDoH requires complex and often uncomfortable conversations. These deeply personal interactions require a level of time commitment, trust and empathy that is hard to build in today’s fast-paced healthcare environment.

The challenges ahead for us to tackle:

Even with the important strides made in these SDoH initiatives, critical challenges threaten sustainable, long term improvements. Healthcare organizations, providers, community coordinators and strategic business partners all require the need to access, understand and share structured (and unstructured) data about patients. In addition, that data must be organized properly in order to power A.I. technologies that can provide solutions at scale. Finally, reimbursement support from CMS must grow as the evidence shows the importance of managing the whole person: social circumstances, behavioral and medical conditions. 

Data consistency and interoperability is a must. 

In order to work together, all stakeholders in SDoH initiatives must have access to structured (think EHRs) and unstructured data (think social media) in a useable format that supports coordination between health care organizations and their partners. Standardizing, organizing, analyzing and sharing that data will enable collaboration with data that is relevant in real-time.

Technology is the means to scalability.

While regional programs offer targeted help, SDoH initiatives won’t have a meaningful impact on population health outcomes or costs until we can truly scale our efforts. Scaling what works across geographies and patient populations requires the use of technology such as predictive analytics and AI. 

For example, identifying behavioral and SDOH issues in combination with medical claims can be particularly powerful in matching needed services to individuals and populations. How does technology help do this at scale? Natural language processing mines clinical notes while machine learning informs algorithms to help us create more impact. 

Ongoing commitment in supporting SDoH care from CMS is critical

Starting in 2020, Medicare Advantage and Part D plans can offer supplemental benefits that impact SDoH. Examples of these benefits may include meal delivery, transportation to the grocery store, or in-home services that improve the safety and health of the home environment. Other potential benefits include healthy food plans, nutrition services, and non-emergency medical transportation. This commitment to financial support is imperative to future success and must be budgeted beyond 2020.

In 2019 our healthcare system and the current state of our data fall short of showing us a complete picture of our patients that includes SDoH but also, must contemplate more silent threats such as chronic loneliness. As we continue to innovate solutions, it’s critical that we publish what we learn and keep our collective eyes on how we can scale what works. While AHIP’s recently launched Project Link is a great step towards needed collaboration, we have a long road ahead.

Carol Murdock is chief commercial officer at Catasys, a leading AI and technology-enabled healthcare company working with health plans to improve medical outcomes and reduce cost.

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