How providers and payers are shifting their focus to social determinants of health

Health equity continues to be a major challenge in the United States:

During the pandemic, we saw that Black people who contracted COVID-19 were almost 3x as likely as White people to require hospitalization, and 2x as likely to die.

According to the CDC, American Indian and Non-Hispanic Black populations are at higher risk of developing diabetes.

A study found that in all categories of income, Black people were at two to three times greater risk of STIs than White people of the same Socioeconomic status.

These disparities are due primarily to differences in access to care. According to a GoodRx study, more than 80 percent of the country lacks adequate access to healthcare, with more than a third living in areas deemed healthcare deserts.

As the medical community increasingly recognizes the impact of contributors to health inequity, Social Determinants of Health (SDoH) are becoming a critical factor in payer and provider conversations about better managing health.

There are 5 key elements to SDoH:

• Economic stability
• Education access and quality
• Health care access and quality
• Neighborhood and built environment
• Social and community context

Examples of SDoH in the real world include safe housing, dependable transportation, good education, access to nutritious food, and literacy/language. Each of these factors play a tangible role in helping patients individually and populations at large establish and maintain health.

With this recognition, we’re seeing payers and providers offering new programs in their communities. For example:

Governments and universities are offering at-home testing for patients at risk of certain diseases: Coming out of the acute pandemic phase, the Wisconsin Department of Health Services recognized that HIV and STI rates were rising. The Department began offering free at-home HIV and STI testing to increase the availability of and access to testing for the uninsured, those who live far from testing sites, and/or patients afraid to test in-person due to social stigma. In a pilot, the Department sent out hundreds of kits, mostly to constituents in rural areas, and 58 percent of recipients completed or plan to complete tests. Similarly, a top Historically Black College/University (HBCU) is offering free at-home testing and treatment to students after seeing STI positivity rates of 30 percent at a health fair. The at-home program helped bring that rate down to 13 percent, and the program will continue until testing rates are under 10 percent. 

Hospitals are opening food pantries: There is a direct link between nutrition and health as poor nutrition is a leading cause of illness, particularly in minority communities. any communities though lack access to nutritious food options, perpetuating a major source of health inequityTo fill those gaps, we’re starting to see hospitals open their own community food pantries. One example is Intermountain Primary Children’s Hospital in Utah, a state where 1 in 10 children suffer from food insecurity. In making the announcement, the hospital’s CEO said, “Giving food to those who need it can make a world of difference in their health and wellbeing and influence their health for years into the future.”

Payers are contributing to affordable housing initiatives: Humana is one healthcare payer that recently announced a major investment in affordable housing – the company has committed to investing $90M in total in this area. In making the announcement, the president of Humana’s Medicaid business said, “Through creative partnerships in affordable housing, we can help people gain access to safe and quality places to live and provide the stability they need to focus on achieving their best health." Although most don’t think of housing as an important contributor to healthcare, it’s almost impossible for patients to develop and maintain healthy behaviors or habits if they’re living situations are unstable. Affordable housing is a much bigger social issue, but it’s telling that national payers like Humana, Aetna, and UnitedHealth all have launched affordable housing programs in the last three years.

If all this has you thinking about how to better focus on SDoH in your facility or community, here’s some advice:

Think hard about the unique needs in your community – they aren’t the same everywhere. And one size does NOT fit all. It’s important to think about what are the biggest needs for your local community and develop programs that have tangible impact and scalability.

Think about how to make the program sustainable rather than stochastic. There is typically no shortage of ideas – the challenge is executing at scale.

Have specific and representative metrics to measure the impact of programs. The only way to improve is to have objective information to assess progress,identify where programs need modification, and lean in on areas of success.

SDoH – and anything else that falls outside of typical medical treatment - is rarely covered in medical school. But it’s something that healthcare providers experience in practice constantly . And the more you see it personally, the more you realize that delivering effective healthcare often transcends the boundaries of “traditional medicine.” However, we as healthcare providers cannot ignore how much patient and population-level health is impacted by what happens outside the hospital or clinic. And the sooner we start actively strategizing and implementing programs that address community needs, the more we’re able to raise levels of health and wellness in large scale, pervasive ways.

Saquib Rahim, MD, MBA, is the Director of Healthcare Innovation for SimpleHealthKit.