By Chloe Hillard

 

Social determinants of health are a hot topic in the health care industry. Increasingly, providers and policymakers realize that in order to provide quality care, you need to treat the whole person. That means taking social determinants of health into account in patient care. Social determinants of health (SDOH) are the “conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.”[1] They include factors such as income, education, food insecurity, housing, access to care, and so much more.[2] These factors can positively or negatively impact a person’s health. Research shows that SDOH may impact a person’s health more than health care or their lifestyle choices.[3] Some studies show that SDOH control as much as 30-55% of health outcomes.[4]

 

There have been numerous initiatives to improve a person’s health by focusing on social determinants of health. For example, in 2016 the Center for Medicare and Medicaid Innovation (CMMI) introduced the Accountable Health Communities model.[5] This model focused on connecting Medicare and Medicaid beneficiaries to community resources to serve their health-related social needs (i.e., housing instability, food insecurity, utility needs, interpersonal violence, and transportation needs).[6] Various state Medicaid programs have also worked to address the social determinants of health. For example, Oregon provides Medicaid funding that can be used for “health-related services”, which can target SDOH.[7] Oregon has used this funding to provide Meals on Wheels to Medicaid beneficiaries who are recently discharged from the hospital and need food assistance.[8] They have also used this funding to connect pregnant women with social services, including housing, food, and income assistance.[9]

 

Despite the numerous initiatives to address social determinants of health in patient care, providers still struggle to incorporate SDOH into care because they lack the necessary data capabilities. One problem providers face is data standardization. When a patient presents at a hospital, the provider may note various SDOH in free-form notes in the patient file. Alternatively, they may use a specific code to document a SDOH. The problem is lack of consistency across points of care, or even necessarily within the same care facility. As a result, it is difficult to accurately document a patient’s SDOH and treat them accordingly. Lack of standardization makes both data collection and data sharing difficult. “The differences in how providers collect housing data, for example, can include different definitions, metadata, and measurement. Moreover, a wide variety of screening tools are currently used in clinical settings to capture data about the social determinants of health.”[10] Without that consistency, it is difficult to accurately and appropriately treat patients, taking SDOH into account.

 

In examining this issue, CODE recommended that HHS should develop a SDOH data strategy, which should, among other things, define and standardize SDOH data.[11] “This can include improving and aligning open-source assessment tools, adopting data standards and definitions, and developing a data governance body.”[12] Once there is data standardization, providers and policymakers can better track SDOH data and implement programs that incentivize treatment of the whole person.

 

[1] Social Determinants of Health, World Health Org., https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1.

[2] Id.

[3] Id.

[4] Id.

[5] Accountable Health Communities Model, Centers for Medicare & Medicaid Serv., https://innovation.cms.gov/innovation-models/ahcm (Dec. 18, 2020).

[6] Id.

[7] Chris DeMars, Oregon Bridges the Gap Between Health Care and Community-Based Health, HealthAffairs,https://healthaffairs.org/blog/2015/02/12/oregon-bridges-the-gap-between-health-care-and-community-based-health/ (Feb. 12, 2015).

[8] Id.

[9] Id.

[10] CODE, Leveraging Data on the Social Determinants of Health (Dec. 2019).

[11] Id.

[12] Id.

Image Source: “File:Pre-Existing Condition – The Noun Project.svg” by CO. Department of Health Care Policy and Financing is marked with CC0 1.0, https://search.creativecommons.org/photos/9bc3f9b1-ecc8-41d0-bb4f-fda96d8bc67a.