The drive toward value-based payments in healthcare means that doctors will have to pay more attention to the social, economic and environmental factors that affect their patients’ health.
Collectively, these factors are known as “social determinants of health.” If a patient can’t afford his or her medications, for example, this is a social determinant of health that could possibly be addressed by finding a pharmacy that sells that drug at a lower price.
Where practices have access to outside support, some physicians are beginning to make a dent in addressing issues related to social determinants of health—and say they are providing better care as a result.
For example, in Vermont, 85% of primary care practices participate in the Vermont Blueprint for Health, a state program that has organized community health teams (CHTs) to help practices deal with social determinants of health.
Gregory King, MD, a partner in a small family practice in Bennington, Vermont, says the specialists on these teams—including nurse care managers, social workers, behavioral health counselors, dietitians and health educators—help him care for complex patients in ways that were previously impossible.
Before King’s practice joined the Blueprint, he says, he’d encourage patients with socioeconomic and other non-medical challenges to get in touch with various community agencies. But his office didn’t have time to look up contact information for the patients or to introduce them to the right people at the agencies. So his advice had little effect.
“But now with the CHT, I can delegate it to the team, and they know where to send the patient,” King says. “And now those issues are getting addressed.”
Some healthcare organizations, recognizing that a proactive strategy for social determinants of health can help reduce the cost of caring for high-needs patients, are also beginning to address these factors, says Eric Schneider, MD, senior vice president of policy and research at The Commonwealth Fund, a New York-based healthcare research and advocacy foundation.
Among the healthcare providers that have started programs for social determinants of health is Montefiore Health System in New York City. Montefiore has hired about 600 care managers, including nurses, social workers and health educators, who address the chronic diseases of high-cost patients and link them with community resources.
Some Montefiore physicians have high praise for the program. For example, Asif Ansari, MD, medical director of the Montefiore Medical Group’s Grand Concourse practice, says that he and his colleagues know the
socioeconomic cards are stacked against their poorer patients, many of whom have trouble paying for their medications, and lack transportation and access to healthy food.
“Our physicians understand that we need this collaboration, this support and these resources to impact our patients’ lives and their health,” he says, referring to the social workers and other non-medical professionals at Montefiore. “When I compare practicing here 10 years ago and now, the difference in what I can do for my patients is significant.”
Doctors need help
Most physicians believe that unmet social needs lead to worse health, according to a 2011 national survey by the Robert Wood Johnson Foundation. They think it’s important to address factors such as fitness, nutrition and transportation; doctors in urban areas also stress the need to provide assistance with employment, housing and adult education.