Social Determinants of Health Still Top of Mind in the Fight for Widespread Wellness
Social determinants of health: the flavor of the day, the hot topic, the scapegoat, and, at long last, the center of attention in US healthcare. Previously overlooked and discounted, social determinants of health, or SDOH, can no longer be ignored. “Indeed, both the private and public sectors are recognizing that SDOH will help society achieve a better relationship between health care costs and quality” (spglobal.com, ¶1). Previous efforts taken to achieve healthcare reform have had mixed results, but SDOH have opened a newer, wider door through which providers and provider partners can usher in an era defined by the highest quality care coupled with the greatest cost savings.
Connecting the dots between costs and outcomes necessitates the incorporation and consideration of SDOH. “According to the CDC, five main factors contribute to a person’s health:
- Individual behavior (alcohol use, smoking, drug use, unprotected sex);
- Social environment (gender, income, discrimination factors);
- Physical environment (where one lives and living conditions); and
- Access to health services and health insurance” (spglobal.com, ¶4).
These five factors have a greater overall impact on patient health than clinical intervention does and impacting these factors requires the acknowledgment and addressing of underlying societal issues. The COVID-19 pandemic has cast an unfortunate, but unignorable spotlight on the impacts of SDOH on health outcomes. The most vulnerable members of our society have been most significantly impacted, often because of deficiencies or challenges associated with one or more of the CDC’s five main factors of personal health. Individuals living in crowded conditions, such as those experiencing homelessness, are at increased risk of disease due to that lack of physical separation compounded by a lack of access to testing and care. Low-income adults are more likely to suffer from chronic conditions, putting them at greater risk of developing some of the more serious side effects of COVID-19.
It is clear that SDOH is no longer just a trend but an up-and-coming healthcare driver. Care plans and public policy alike will seek to address SDOH and the associated externalities. As we move forwards towards this period of healthcare transformation, it is important to stop and take of stock of our current position, how we got to this current point, and where we want to “go” in the future.
- High Healthcare Costs are not Leading to Better Care nor Better Outcomes
The United States spends more money on healthcare than any other country, both from the perspective of spending per capita and spending as a share of GDP. The United States simultaneously has a lower life expectancy and slower improvement in life expectancy when compared to similarly-sized and developed nations. “In 2018, the U.S. spent 16.9% of its GDP on health care, which was well above that of the next-highest country, Switzerland, at 12.2%. (According to a different source, the Centers for Medicare & Medicaid Services (CMS), health expenditures accounted for 17.7% of the U.S.’s GDP in 2018 and are projected to continue increasing.)” (spglobal.com, ¶7)
The United States has explored many strategies to lower costs and improve outcomes, such as managing drug prices and introducing new payment models, but policymakers and healthcare professionals alike are coming to terms with the fact that SDOH are critical factors in healthcare cost and delivery. “While CMS has stated that “unmet health-related social needs, such as food insecurity and inadequate or unstable housing, may increase the risk of developing chronic conditions, reduce an individual’s ability to manage these conditions, increase health care costs, and lead to avoidable health care utilization.” Ensuring access to a stable, safe, positive environment where basic resource needs are continually met is critical to empower people to manage their own baseline health and any chronic conditions.
- Improving the Physical Health of the Nation Requires Addressing the Social and Economic Health of Citizens
SDOH programs have become increasingly common tools in the drive to improve the health of the United States population. Programs and initiatives meant to address one or more SDOH have been adopted at both the federal and state levels to the point that “the Department of Health and Human Services (HHS) included “creat[ing] social and physical environments that promote good health for all” as one of only four overarching goals in “Healthy People 2020,” a set of objectives identified once a decade to improve the health of all Americans” (spglobal.com, ¶10).
There is a strong argument that economic status is the most impactful SDOH. Poverty, unfortunately, does not like to travel alone. It oftentimes brings along unsecure or inadequate living conditions, lack of access to food, and limited healthcare, among other issues, exacerbating already challenging situations. In response, CMS has started to include non-medical services, such as in-home support services, into benefit plans for Medicare as well as other support programs for individuals managing chronic conditions. At the state level, “the Social Determinants Accelerator Act, bi-partisan federal legislation, was introduced to assist states and communities in coordinating programs that address social determinants, to improve the health and well-being of individuals participating in Medicaid” (spglobal.com, ¶12). Most recently, the Helping Ensure Access to Local TeleHealth (HEALTH) Act was introduced in June of 2020, which establishes permeant Medicare payments for telehealth services rendered at eligible health centers.
- Community Partners Lead the Way for Providers to Better Support Their Patients
As the shift to value-based care continues, cost reduction and outcome improvement have been incorporated into reimbursement payment methodologies in an effort to incentivize providers to adopt and adhere to value-based programs. Value-based care, by nature of what it is, is rooted in maintaining health at home. Payers and providers alike recognize the incredible impact of SDOH on baseline health and many have implemented ambitious programs in partnership with local communities to address areas where SDOH may be having a negative effect on the health of a population.
- Alternative Payment Models and SDOH are Driving Innovation and Expansion
As more and more alternative payment models become available, companies are taking note of the trend and adapting, shifting, and in some cases, even splitting off into new entities to make the most of these new payment structures. New entities are springing up to meet the needs created by the drive towards ultimate efficiency and maximum savings.
In addition to the human component of the puzzle, “SDOH now have a part in determining reimbursement” (spglobal.com, ¶19) as well. The International Classification of Diseases, Tenth Revision (ICD-10), the coding system utilized in health care “to classify and code all diagnoses, symptoms, and procedures related to a person’s care” (spglobal.com, ¶19), now includes codes specific to SDOH, known as the ICD-10-CM Z codes. These codes indicate factors that could impact an individual’s baseline health or explain the cause of a medical encounter that cannot be attributed to a specific disease or injury classifiable by other ICD-10-CM codes. Calls to include additional codes that further take into account SDOH have been met with enthusiasm from providers and payers alike. “The addition of social determinants to the formal coding system establishes a consistent, predictable way of tracking nonmedical barriers to health, allowing providers and payors to coordinate to address these factors and track their influence on health care costs” (spglobal.com, ¶20).
- Consistency in Collection is Key
Data is the key that allows modern medicine to operate the way it does. The ability to collect, store, average, and analyze data, among other actions, has opened countless doors to new treatments and success in preventative care and screening. With the increased adoption of value-based care reimbursement, data has taken on even greater importance. When reimbursement is tied to performance and performance is based on patient data, it is understandable that providers and payers alike have high expectations for the quality, consistency, breadth, and depth of the data collected. Partnering with community-based organizations can provide healthcare entities access to SDOH data that completes the “picture” of a patient or patients, allowing for more targeted care and support.
In order to fix an issue, one must first know what that issue is, and it is abundantly clear that social determinants of health are impacting people in a way that impedes the nationwide drive towards higher quality, lower-cost care. The beginnings of a “fix” lies with the providers, payers, and other entities who participate in new programs that account for and address SDOH.
Innovista Health Solutions is a population health management company that offers management and support services to guide independent physician networks, medical groups, and health systems through the ever-changing landscape of value-based care. With services and toolsets including network development, population health management, delegated services, data reporting, and strategic capital investments, Innovista is structured to help its clients succeed in their Commercial, Medicare, and Medicaid value programs. Innovista is a single resource for physician integrated models to gain access to innovative technology, expert programs, actionable data insights, financial resources, and growth opportunities, to navigate and succeed in value-based and/or risk-based contracts.
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