Over the past 10 years, the shift to value-based care (VBC) and accountable care organizations has been slow, but fruitful. Today, more than half of healthcare groups use different payment methods, and 40% of U.S. healthcare payments are tied to these methods. These models aim to reduce the cost of care while fostering appropriate patient care and positive outcomes.
Understanding and addressing social determinants of health (SDoH) are emerging as critical factors in achieving the goals of VBC. SDoH are things like education, job status, housing, safety, neighborhood, and racial bias that affect people’s health. Research shows that SDoH account for up to 80% of health outcomes, with clinical care accounting for only 20%.
People are starting to understand how important SDoH is for well-being, but there is still a challenge, as mentioned in a recent paper from the University of Pennsylvania.
Patients in ACOs have more health risks, but providers in areas with social risks are less likely to join ACOs. This might be because certain providers, like Federally Qualified Health Centers (FQHCs), mostly help people with high social risks. Some ACO models focus on cutting waste, but for many people, the main problem is not getting enough care or spending.
The Role of SDoH Data in High-Value Care
The study shows that high-quality care might mean more services and spending, and SDoH data can help target care better.
SDoH can do nothing to improve health outcomes, however, if data can’t be gathered and analyzed for insights. Unfortunately, electronic health record (EHR) systems weren’t originally designed to capture SDoH data. Even if staff wanted to collect patient SDoH data at check-in, there was no place to easily record it. If it was captured, it went into notes fields that were free text and often buried four-screens deep, providing little clinical or analytical value.
As the importance of SDoHs has become apparent, EHRs and their data schema have, in many cases, evolved to enable data to be captured regarding a patient’s living situation, employment, access to healthy foods, sense of physical safety, access to transportation and similar SDoH. Having that information captured in the EHR can be invaluable, helping knit together risks and complexities that would have otherwise gone undetected and not discussed.
Bridging the Gap between Medical Models and Social Services
In the medical realm, then, there is marked progress in collecting and recording data around social determinants in a way that can enable whole-person care. But we’re starting to learn what data, actions, and social factors matter most for different groups of people. Until we do, we may be inadvertently sub-optimizing care in our quest for value. Some ACO models focus on cutting waste, but for many, the main problem is not getting enough care or spending.
Organizations such as Federally Qualified Health Centers (FQHCs), community health centers and social service agencies are struggling with capturing more SDoH data, such as referrals to Meals on Wheels, and tying that that data to medical and behavioral health outcomes will help reinforce the value of more services and more spending for targeted populations.
Organizations like FQHCs and community health centers struggle to collect SDoH data and connect it to medical and behavioral health results. Care providers and agencies are collecting a lot of data, without understanding the data and their overall potential utility. Collecting SDoH data is tricky because we don’t know which data is most important to collect.
Without SDoH information, a patient would simply be diagnosed as diabetic or having a behavioral health condition. Adding social factors, like job status and safety, gives a more complete view of patients and helps providers give better care.
Social Determinants of Health in Action
ED utilization by homeless patients is three times the US norm and has increased 80% over the last 10 years. While not directly causational, numerous studies show housing is key to reducing ED utilization. A $1,000 rent is the same as 45 minutes in the emergency room, so healthcare groups are helping with housing for people who need it.
Hospitals in Portland worked together to spend $21.5M on housing for high-risk people, because it saves money and improves lives in the long run. Data from Portland’s “Housing for Health” shows a savings of $20,000-$30,000 per person per year in emergency room and criminal justice costs.
3 Keys for Leveraging SDoH Data to Drive Value
For providers to take full advantage of SDoH in support of VBC, they must do three things.
First, healthcare providers must keep improving systems to collect SDoH data and analyze it for individual and community care. It’s not helpful if staff ask about safety and nutrition but don’t do anything with the information. You need to analyze the data and have systems in place to help patients early on.
The second thing providers must do is tap into or help build a network for community referrals and care coordination. Our healthcare system is good at connecting points, but life is complicated, especially for people with complex health issues. We need to create a safety web of interconnectedness across the healthcare ecosystem. Innovation around SDoH can be the framework upon which we can build these webs.
Finally, providers must focus on proactive care and outreach, which are the essence of VBC. In some cases, this may mean more care and services, not less. This shows the importance of SDoH and using data to learn about factors that affect health. This knowledge, gained from data across care providers, helps improve health outcomes and lower costs.
Embracing Social Determinants of Health for a Comprehensive Approach to Value-Based Care
In conclusion, adding SDoH to value-based care is important for better healthcare. As the industry continues to evolve, it is vital to recognize and address the role of SDoH in shaping health outcomes. By improving data collection, creating community networks and focusing on early care, healthcare providers can use SDoH data to help patients and communities.
In the end, embracing SDoH will help us better understand patients’ needs, make better decisions, and provide tailored interventions. This will lead to a more interconnected healthcare system that supports the overall health and well-being of our communities.
By working together and focusing on social health factors, we can create a brighter future for everyone, with better public health and quality of life outcomes.
