Did you know that in-office medical care accounts for only 10-20% of health outcomes? It’s estimated that the other 80-90% rely on the Social Determinants of Health (SDoH) or the conditions in the environments where people live, work, play, and age.
Despite investing trillions of dollars every year on healthcare spending, America has the lowest average lifespan compared to other developed nations. Unfortunately, even as spending increases, patient outcomes remain stagnant.
The Centers for Medicare and Medicaid Services (CMS) began emphasizing value-based care (VBC) over quantity of provider visits in 2008. Since then, a growing number of hospitals and physician practices have started screening for SDoH, but there’s still work to do.
Why Is Screening For The Social Determinants of Health Important?
SDoH, such as housing, food security, and transportation directly affect health outcomes. However, a recent report by Waystar found that a majority of patients still don’t discuss SDoH with their doctors. The study found that 78% of Americans identified having challenges in at least one SDoH risk category. However, only 22% of patients surveyed actually discussed these issues with their physicians.
Another study, recently published in the Journal of the American Medical Association (JAMA), uncovered similar numbers. In the JAMA study, researchers evaluated data from more than 2,000 physician practices and 700 hospitals.
The study’s main focus was to research how often hospitals and physicians screened for the five social needs, highlighted in CMS’ Accountable Health Communities Model:
- Food insecurity
- Housing instability
- Utility needs
- Transportation needs
- Experience of interpersonal violence
After reviewing all of the data, researchers found that only 24.4% of hospitals and 15.6% of physician practices screen for all five SDoH. Even more startling however, is that 8.0% of hospitals and 33.3% of physician practices reported no screening for SDoH at all.
Why Aren’t More Healthcare Entities Screening For SDoH?
If research shows that screening for the SDoH can have a positive impact on whole person care, why aren’t more facilities implementing these procedures?
There are a few reasons:
Physician burnout
Many physician practices are still transitioning from quantity-based care to value-based care. As a result, some doctors see between 25-30 patients a day. With such a quick turnaround, there’s little time for doctors to catch their breath, much less, add an entirely new screening protocol to their intake process.
Lack of resources
A lack of financial, technological, and staff resources also contributes to the problem. In fact, the JAMA study found that of the physician’s practices that conducted no SDOH screening, 51% reported a lack of financial resources as their number one barrier to screening, while 60% of hospitals reported the same.
Poor communication
Of the physicians who do conduct SDoH screenings, many don’t have the training, resources, or time to address their patients’ psychological, environmental, and social needs. What’s more, even if a physician is able to identify a problem, such as homelessness or a lack of transportation, they often don’t know where to refer their clients for additional assistance.
Strategy: The Key to Better SDoH Screening
Before physician practices and hospitals can adequately screen for SDoH, they must develop a strategy, programs, and infrastructure to support these initiatives. There’s no single, clear cut path to success but the JAMA study recommends focusing on a few areas, in particular:
- Introducing new screening technology
- Implementing new intake processes
- Offering alternative ways to connect with patients
The Link Between Data Sharing and SDoH Outcomes
In order to improve patient outcomes, healthcare and community organizations must be willing to invest in initiatives that address the SDoH, beyond traditional medical services.
One data sharing initiative that’s proven successful is the National Association of Community Health Centers’ (NACHC) PRAPARE protocol. The PRAPARE protocol is used by health centers, physician practices, and hospitals around the nation. Embedded in electronic health records, PRAPARE offers a series of questions that doctors can ask patients to discover social conditions that might harm their health. The tool is free and available to all types of providers.
If the PRAPARE protocol isn’t right for your practice, there are still steps you can take to encourage better integration of social and healthcare.
A recent report by the National Academies Press, Integrating Social Care into the Delivery of Healthcare: Moving Upstream to Improve the Nation’s Health, makes five recommendations designed to enable better collaboration between doctors and social service providers.
The five recommendations are:
- Design healthcare delivery to integrate social care into healthcare, guided by the five healthcare system activities—awareness, adjustment, assistance, alignment, and advocacy.
- Build a workforce to integrate social care into healthcare delivery.
- Develop a digital infrastructure that is interoperable between healthcare and social care organizations.
- Finance the integration of healthcare and social care.
- Fund, conduct, and translate research and evaluation on the effectiveness and implementation of social care practices in healthcare settings.
In addition, a number of other organizations, including the American Academy of Pediatrics and the National Association of Community Health Centers have developed tools to help providers identify patients with social needs and offer them community-based support.
By connecting social service organizations and medical providers through data sharing initiatives, screening for SDoH isn’t just possible, it’s easy.
