Supporting a Value-Based Care Structure: Social Determinants of Health (SDoH)

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Original story posted on: September 23, 2019

The SDoH are an essential element to providing patient care while addressing social needs.

What determines health?

While medical care is one determinant of one’s health, it plays a minor role in comparison to the economic and social conditions of an individual, otherwise known as social determinants of health (SDoH): factors influencing patient outcomes that fall outside of the scope of traditional medicine.

Combining consumer behavior data and healthcare data to include SDoH factors essentially creates a blueprint of a patient’s overall ability to maintain wellness. These determinants are also helpful in defining and addressing challenges within healthcare populations.

Healthcare is pursuing information not only related to care provided within healthcare organizations, but also factors that may affect patients outside the walls of the organization. Economic stability, social and community context, neighborhood and environment, and education all play a part in a patient’s overall ability to maintain their health. This is precisely why the healthcare industry is seeing an increased focus on SDoH. 

The World Health Organization (WHO) has described social determinants as the circumstances in which people grow, live, work, and age, and the systems designed to address illness. The conditions in which people live and die are, in turn, shaped by political, social, and economic forces. There has been significant evidence showing that social and environmental conditions are driving health outcomes, as the social conditions in which people are born, live, and work is the most critical determinant of good or poor health. Abstracting data related to social determinants has proven to support a healthcare provider’s efforts to reduce unnecessary admission, improve life stability, and provide access to resources.

The number of healthcare organizations with a formal program aimed at addressing SDoH has increased 30 percent over the last three years. SDoH screening is integrated into their clinical workflow. The majority of screenings are taken at the point of patient intake. High-risk patients include those with two chronic conditions and Medicaid members. Healthcare access, literacy, and economic stability are the most common SDoH for which healthcare organizations screen.

The key goal of this program is to assist with the coordination of services for patients identified with SDoH needs. Mental health and substance abuse have the most impact on SDoH. A recent study by Healthcare Benchmarks, published in 2019, demonstrates a 29 percent decrease in the total cost of care when SDoH are captured. A few of the benefits of this include keeping patients at home instead of having them travel to a healthcare setting, assisting patients with mobility issues, early identification of a patient’s inability to connect to community resources, and identifying transportation needs to assist with increased follow-up, just to name a few, all of which have shown an impact in reducing the cost of care.

How do healthcare organizations capture data related to SDoH factors? The most frequently leveraged roles assigned to capture such information are patient intake, member enrollment, or admissions staff. Besides, a healthcare organization must implement cross-sectoral collaboration and create a workflow and screening tool for identifying and capturing this information. Implementation of an electronic health record (EHR) screening tool is most often used to approach SDoH. However, before embarking on the journey of capturing SDoH factors, organizations need to ascertain their existing population to address the list of different factors adequately.

Regardless of the how and why of SDoH factors, it is imperative that organizations remain abreast of the increasing needs and potential requirements in capturing these factors. It is speculated that the Centers for Medicare & Medicaid Services (CMS) may begin reimbursing for certain SDoH factors relating to meals and transportation as early as 2020. At the same time, reporting these factors will help move organizations one step closer to developing a patient health strategy and replacing traditional care with a holistic, value-based structure.

Programing Note:

Listen to Susan Gatehouse report this story live today during Talk Ten Tuesdays, 10-10:30 a.m. EST.

Susan Gatehouse, RHIT, CCS,CPC, AHIMA-Approved ICD-10-CM/PCS Trainer

Susan Gatehouse is the founder and chief executive officer of Axea Solutions. An industry expert in revenue cycle management, Gatehouse established Axea Solutions in 1998, and currently partners with healthcare organizations across the nation, to craft solutions for unique challenges in the dynamic world of healthcare reimbursement and data management.

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