Why Measurement Is Crucial for Social Determinants of Health (SDOH) Initiatives

Inequitable health care access and outcomes have been an issue for years, but they took on added visibility during the Covid-19 pandemic. We saw significant impact on the burden of many social determinants of health (SDOH), including socioeconomic status, education, employment and access to health care. Millions of workers lost their jobs, or a sizable portion of their income, which in turn hampered their ability to buy food or maintain suitable housing. A June 2022 Brookings study found that 16 million American adults still struggle with “long Covid,” and as many as 4 million are out of work, resulting in lost wages of more than $170 billion per year. 

A March 2022 Kaiser Family Foundation study tracked more of Covid’s impact across SDOH:

• 61% of adults reported at least a little difficulty paying for usual household expenses in the past 7 days, and 32% used credit cards or loans to meet household spending needs.
• 31% reported a likelihood of having to leave their house in the next 2 months due to foreclosure or eviction.

Socioeconomic status affects the opportunities one has to pursue health throughout life and can affect multiple generations. For example, children who grow up in undereducated households are more likely to experience material hardship as adults. In addition to shifting the inequitable socioeconomic conditions which underpin health inequity, addressing individuals’ unmet social needs is critical to reducing health disparities and improving health outcomes in the near term.

It’s one thing to recognize the fact of social needs, but addressing them in pursuit of health equity involves investing in helping patients navigate to appropriate social need interventions. It’s only possible to address needs when you know they exist; setting measurement goals and standards can help. 

Addressing Health Care Equity

Challenges to empowering more equitable health opportunities are diverse. Many structural and institutional barriers that plague broader society are compounded within health care. Some communities face systemic barriers to accessing food, healthy environmental conditions, reliable transportation and secure housing. These barriers lead to a disproportionate burden of unmet social need among minoritized communities and present substantial challenges to achieving optimal and equitable health outcomes across the population. For example, Black, non-Hispanic individuals are over 2 times as likely to experience hunger as compared to the general population; experiencing food insecurity results in a 2-3x increase in the likelihood of developing diabetes, and further contributes to risk of complications in individuals who have diabetes. Identifying and addressing social needs must therefore be an integral part of efforts to dismantle disparities and achieve equity in our health care system.  

That said, distrust of the health care system, in the context of its history of medical racism and discrimination, makes some patients hesitant to share vital information with their provider. That mistrust, combined with inconsistent efforts to collect, catalog and analyze socioeconomic data, leaves payers, health systems, policymakers and other stakeholders without necessary information to drive change. 

Measurement Drives Success

The admonition “measure twice, cut once” is sound: Good planning can drive good outcomes. But if you never measure, it can be hard to get it right—or to improve on your mistakes. Health care providers and payers typically use HEDIS^® (Health Care Effectiveness Data and Information Set) measures to help “get it right”—to understand health plan performance and evaluate where improvements can be made. HEDIS measures assess preventive care and identify performance gaps across categories such as Effectiveness of Care, Access/Availability of Care and Utilization.

Most recently, HEDIS has focused on evaluating unmet social needs, because it’s only possible to provide excellent outcomes if you also address the social factors that impact health. For example, for a person struggling with hypertension or heart disease, a provider might recommend dietary changes to improve health. But if that patient lacks income and transportation, they might not be able to access the food to support their nutritional needs and preferences.  

Without proper screening, a patient’s background information and social factors affecting their health might remain unknown. A new HEDIS measure—Social Need Screening and Intervention (SNS-E)—addresses this. Health plans can use this measure to evaluate members for unmet food, housing and transportation needs, and link patients to supportive interventions in the community, like food banks, housing assistance programs or affordable transportation. 

Data analytics are vital for improving health equity. Closing care gaps starts with collecting data but it doesn’t end there. Here are three other steps to equitable health: 

• Build standards that assess whether health plans have the structure to mitigate social risks and meet health-related social needs.
• Develop performance measures that determine if health plan members are screened for health-related and broader social needs—and whether and how those needs are met.
• Identify ways to assess equitable outcomes, such as community-level outcomes that evaluate and incentivize a health plan’s disparities reduction efforts.

The power of HEDIS measures is that they consider diverse factors that shape a person’s physical, mental and emotional well-being. 

If you can’t measure it, you can’t see it. If you can’t see it, you can’t fix it—and it is long past time for us to fix the problem of health inequity.