In the 20 or so years since social determinants of health (SDOH) became a mainstream concept, mounting evidence has linked SDOH factors to poorer health and higher health costs. Economically disadvantaged people – those who are poor, homeless, live in unsafe neighborhoods, lack access to transportation or well-paying jobs – are more likely to get sick and be hospitalized, remain in the hospital longer, and to be readmitted within 30 days of discharge. That translates to tremendous expense increases for payers and reduced reimbursements from CMS as a result of the interrelated impact on readmissions and other quality measures.

A Kaiser Permanente study on SDOH, just released June 4th, 2019, found that 68% of Americans surveyed had at least one unmet social need in the past year. More than a quarter of those surveyed said that an unmet social need was a barrier to health, with 21% prioritizing food or rent over medication or seeing a doctor.

The survey, “Social Needs in America,” also found that Americans overwhelmingly want health care providers to be involved in identifying and addressing these non-medical social needs. It makes sense – when the healthcare system gets involved with broader influencers of health, the results show improved health outcomes and reduced spending. A 2016 study by the Robert Wood Johnson Foundation reported that, after 33,000 people were referred to community-based programs and services, emergency department (ED) visits dropped 17%, emergency spending dropped 26%, inpatient spending dropped 53%, and outpatient spending decreased by 23%.

To fully embrace SDOH, payers must make a paradigm shift -– and look at the healthcare “problem” with a new lens.

  • Kaiser Permanente has launched social health networks in its service areas.
  • Anthem BCBS has added programming and benefits, including home-delivered meals, transportation for medical visits, and a personal home helper to improve a member’s ability to live independently
  • In fact, some 80% of insurers are factoring social determinants of health into their member programs, according to the 8th annual Industry Pulse survey, taken in 2018, and a recent industry report found 12-15% of health systems and managed care organizations expect to invest in SDOH referral platforms by 2023.
  • In April, CMS announced that in 2020, chronically ill Medicare Advantage patients may access a broader range of benefits “that are not necessarily health-related…(and) can address social determinants of health for beneficiaries with chronic disease.” That means, for example, a Medicare Advantage member with asthma may be able to get coverage for home air purifiers or carpet cleaning services; and a diabetes or heart failure patient could access food plans or dietician services.

According to Kelley O. Smith, RN, MPH, Chief Clinical Officer at Envision Health. “SDOH requires not only a new set of rules but a new set of roles with government and community agencies working collaboratively with hospitals, physician groups, and pharmacies. Each of these traditionally siloed players must now truly care what happens to people long after they’ve left the protective cocoon of the social worker’s office, hospital room, doctor’s office or pharmacy counter.”

“We’ve begun to see traditional players collaborate in ways that are anything but traditional to help address barriers to health and wellbeing. But we all know that lasting change will require some type of catalyst that changes the rules and automates burdensome processes and actually makes physicians’ and other clinicians’ lives easier.”

To sum it up, Smith says, “I’ve seen firsthand how leading health systems have used the Wellopp SDOH platform to leverage a combination of technology, clinical expertise, and new processes to actually save physicians time while they address the underlying issues related to social determinants. I believe making the shift to SDOH will require this type of a game-changer — and we all need to open our eyes to the real daily life issues that consumers face on the rocky road to health and happiness.”