by Elizabeth Hofheinz, M.P.H., M.Ed., November 1, 2019
“Take your medication and follow up with me in two weeks” seems like a straightforward physician recommendation. But what if the medication is too expensive for this patient? What if she has no one to drive her to see you in two weeks?
Many physicians—as well as hospital administrators—might
think, “That’s not my bailiwick. I can’t do EVERYTHING.” 
Think again…and think about this:
According to a recent survey by Kaiser Permanente:
- 93% of Americans feel that their medical provider should ask about access to food and balanced meals;
- 83% feel that their medical provider should ask about safe and stable housing;
- 78% feel that their medical provider should ask about social relationships and isolation;
- 77% feel that their medical provider should ask about transportation to work, school, appointments, or activities.1
Not that surgeons will be renting vans to pick up patients, but there is clearly a gap in services that somehow will be filled. That gap is known as Social Determinants of Health (SDOH), defined by the World Health Organization as, “…the conditions in which people are born, grow, 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.”2
But with all of the existing pressures on healthcare providers and systems, who is addressing these needs?
One study found that approximately 24% of hospitals and 16% of physician practices reported screening for food insecurity, housing instability, utility needs, transportation needs, and interpersonal violence.3
And a survey conducted by The Deloitte Center for Health Solutions found that 80% of hospital respondents reported that leadership is committed to establishing and developing processes to systematically address social needs as part of clinical care.4
But how to address these issues? Entrepreneurs, perhaps…they know an opportunity when they see one.
In an article on HealthcareITNews.com https://www.healthcareitnews.com/news/how-sdoh-will-influence-next-wave-health-tech-startups (“How SDOH will influence the next wave of health tech startups,” Bill Siwicki, September 30, 2019), Joanne Lin, a principal at Newark Venture Partners, commented, “…Clinical care is estimated to account for less than 20 percent5 of what affects a person’s overall health outcome.”
Lin noted, “With the regulatory pressure created after the passing of the HITECH Act in 2009, today, more than 95% of hospitals have demonstrated meaningful use of certified health IT and electronic medical records, according to CMS, compared to only about 31% in 2003…If we can collect standardized SDOH data at the individual level, it must also be incorporated into population health management platforms to inform care coordination efforts.”
As indicated in the HealthcareITNews.com article, startups, including Solera, UniteUs and CityBlock Health already have raised hundreds of millions from investors.
“Most of them are focused on tackling the issues related to matching patients with the existing maze of social services, which is an extremely fragmented ecosystem,” Lin noted. “We also are starting to see that the landscape for startups in the SDOH space is rapidly evolving.”
And hospitals?
The Deloitte survey indicates that, “Hospitals that are further along in the journey to value-based care report the largest investments and most activity around addressing social needs…Determining return-on-investment (ROI) for social needs activities requires hospitals to identify meaningful measures, such as quantifiable improvements in health outcomes and cost savings. About one-third of hospitals (35 percent) are tracking cost outcomes from their social needs investments.”
of Health Hospital Survey
And, says the Deloitte research, hospitals that are shifting toward value-based care models are reporting the highest level of investments and the majority of efforts to address social needs.
Not convinced? We’ll end with some thoughts from two orthopedic surgeons/key opinion leaders:
Pierce D. Nunley, M.D. is the Director of the Spine Institute of Louisiana and Associate Professor in the Department of Orthopaedic Surgery at the Louisiana State University Health Sciences Center. Dr. Nunley commented to OSN, “When evaluating patients, particularly for surgical intervention, it is important to understand the social, economic, and educational status of each patient. These impact their ability to understand the informed consent process and their health to undergo a particular procedure. Further, the understanding of post-operative care and their environment play an important role in recovery. For these reasons, there is an emergence and growth of ‘Prehab’ programs that help patients prepare for surgery and recovery that has been proven to improve outcomes and decrease complications. We need to continue to proactively help those patients that are in the most need and not assume their health status or social environment is good or supportive.”
Alex Vaccaro, M.D., Ph.D., M.B.A., President of the Rothman Orthopaedic Institute, is also keeping an eye on social determinants of health, told OSN, “SDOH may have the greatest impact on health outcomes in this nation and is directly related to the significant cost of health care in this country.”
References:
- https://about.kaiserpermanente.org/content/dam/internet/kp/comms/import/uploads/2019/06/KP-Social-Needs-Survey-Key-Findings.pdf
- https://www.who.int/social_determinants/sdh_definition/en/
- https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2751390
- https://www2.deloitte.com/content/dam/Deloitte/us/Documents/life-sciences-health-care/us-lshc-addressing-social-determinants-of-health.pdf
- https://www.countyhealthrankings.org/sites/default/files/Hood_AmJPrevMed_2015.pdf