Social determinants and health equity: What providers can do to better help their patients
Editor’s Note: This is the second blog post in a series in which Leigh Burchell shares the lessons learned from conversations with industry thought leaders during the Virtual ACE Conference Oct 6-8. Watch Social Determinants and Health Equity: Current State and What You Can Do here.
The conversation I had last week with Lasker Foundation CEO Dr. Claire Pomeroy on social determinants of health and what Allscripts clients can do to better incorporate patients’ away-from-the-doctor experiences into their care plans was eye-opening.
Dr. Pomeroy started her presentation (watch here) with the story of a 17-year-old girl who has aged out of the foster care system, is working two jobs with no care, and finds herself unable to afford her asthma medication. She then hooked the audience by revealing that the story was her own. The lesson she lived that day and took into her long career as a physician and advocate for the underserved was clear: We don’t truly heal our patients until we address their life circumstances, all the aspects of how they live and work and age.
Thanks to the COVID-19 pandemic, social determinants of health have been discussed in the mainstream media in a way they never have previously, even if not defined as such. People of color are disproportionately developing the disease and dying at higher rates due to social factors, socio-economic status, lower access to healthcare services, crowded living conditions and working front-line jobs. “Social determinants dramatically impact COVID-19 risk, and it is a clarion call to build back better,” Dr. Pomeroy said.
What are the life experiences that generally get categorized as social determinants and directly tie to variances in health experiences and outcomes?
- Gender and sexual orientation
- Immigration status
- Incarceration history
- Socio-economic class
- Social support
In fact, traditional care delivery affects as little as 10% of a patient’s outcomes; safe neighborhoods, access to healthy food, transportation, social isolation and education are much more important influences. However, it is critical that care providers know that not everything is tied to socio-economic status when it comes to social determinants of health. Pollution, unsafe relationships, substance use disorder, a recent job loss and loneliness are all factors that can cross all levels of income.
According to Dr. Pomeroy, despite perceptions to the contrary, addressing social determinants is not an issue of spending more but spending more wisely. Spending by developed countries as contrasted with investment in social services shows that the United States is an outlier, and other industrial countries see better outcomes. We can afford to move toward health equity if we invest more upstream to head off the need to spend downstream.
So what can be done in our own communities? This isn’t something clinical providers can take on alone; it takes intersectoral collaboration between education, urban planning, criminal justice and more. Allscripts clients who are interested in becoming active in addressing their patients’ social determinants have several options:
- Check out CMS’ Accountable Health Communities, which allow Medicare dollars to be used for housing, transportation and other social services; many states have similar programs within their Medicaid structures. They also offer a screening tool for health-related social needs.
- Download internet-based or app-based options that can be used in your practice or by patients themselves to provide you with more information. We all have access to these tools.
- Investigate programs available in your area, as most social determinant-related work takes place locally. Is there somewhere to get involved with social services organizations? This is critical to knowing what to do when you learn that a patient needs help, such as how you can “prescribe” healthy food delivery or offer Lyft connectivity to the care environment so they don’t miss a follow-up appointment. According to Dr. Pomeroy, those organizations are thirsty for clinical input.
- Evaluate your organization for diversity. Patients are most comfortable seeing care providers who can understand some of their own experience and who look like them. Building trust is critical in enabling an honest dialogue with the providers in your organization.
- Start tracking social determinants of health across your client base. Make it part of the conversation with your clinical leadership team and assess your own business framework for this issue. Again, this is a long-term conversation, but there is a very solid business case for investing in social determinant-driven interventions.
- Are you maximizing your EHR to keep social determinants in mind as you deliver care? Do you have clinical decision alerts embedded specific to this challenge? Are you asking your patients about social determinants as patients check in so you can be mindful of those answers as you diagnose and make treatment recommendations?
We need to give patients the time necessary to really understand them, who they are, and what their life is like outside the practice or hospital. At that point, we will see a clear return in healthier patients and healthier communities.
SDOH 101 for Healthcare: Five Plus Five (National Academies of Medicine)
Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health (National Academies of Sciences, Engineering and Medicine)
Applying Big Data to Improve Social Determinants of Health in Oncology (National Academies of Sciences, Engineering and Medicine)