Readers Write: Engaging Patients with Social Determinants of Health: Is Your Practice Ready?

Engaging Patients with Social Determinants of Health: Is Your Practice Ready?
By Beth Socoski, MBA, MSW, MSCL

Beth Socoski is compliance manager of  InSync Healthcare Solutions of Tampa, FL.

In recent years, the importance of incorporating social determinants of health (SDOH) — the conditions, circumstances, and environmental factors that influence health outcomes — into care delivery has risen to priority status.

Most providers understand that patients with limited access to healthy food, safe living quarters, and income security are higher risk for realizing poor outcomes. They’ve read studies that suggest that SDOH accounts for as much as 90% of an individual’s health.

But although awareness of SDOH’s role in overall health has increased, far too many providers lack actionable knowledge of how to help.

A recent American Academy of Family Physicians (AAFP) survey indicates that 80% of family physicians feel they don’t have adequate time to discuss social determinants during routine consults, and 64% say they lack the staff or resources to do anything even when they identify risk factors.

Therein begs the question facing providers in 2021 and beyond: What can physicians do to improve identification of poor SDOH and do a better job of engaging high-risk patients?

In a recent memo unveiling its Healthy People 2030 initiative, HHS included a list of SDOH that need to be addressed in order to significantly improve quality of life for all Americans. These include everything from racism and domestic violence to polluted air and lack of job opportunities.

Yet many of these underlying social determinants remain unseen during a routine visit and difficult to gauge. The reality is that SDOH often go underreported because physicians are trained to treat acute physical issues, such as an earache, urinary tract infection, or broken arm.

Consequently, opportunities are missed. For example, consider a pediatric asthma patient who is treated only for their condition without insight into their living conditions. If parents are smokers or high levels of air pollution exist, they may be more likely to develop serious respiratory disorders later in life.

Lack of time is another challenge. The US medical system is still largely volume-driven, with the demands for doctors exceeding supply in some areas. With only 15 minutes to interact with a patient for a sick visit on average, providers are less likely to prioritize asking about socio-economic issues or risk factors, epecially since there are likely patients in the waiting room with acute needs.

Referrals to social workers help, but what providers truly long for is a better way of identifying SDOH and the ability to contribute toward improving patient health in a more impactful, meaningful way.

On the positive side, more recent efforts on the regulatory and technology front are beginning to address barriers. In late 2020, the National Committee for Quality Assurance (NCQA) proposed introducing race and ethnicity stratification into select HEDIS measures, with the goal “to advance health equity by leveraging HEDIS to hold health plans accountable for disparities in care among their patient populations.”

Time, staff engagement, and cost can be deterrents for meeting health equity goals for organizations of all sizes. To that end, the Department of Health and Human Services is offering free training with some excellent benefits for staff with professional licenses, such as free continuing education credits required for ongoing licensure.

In December, The Gravity Project, a community-led HL7 Fast Healthcare Interoperability Resources (FHIR) Accelerator, unveiled an EHR implementation and recommendation guide for SDOH data and terminology, which emphasizes food insecurity, housing challenges, and access to transportation.

However, most EHRs used by healthcare providers aren’t loaded with pathways that can direct a physician to next steps when SDOH challenges are identified.

To do a better job of addressing SDOH, physicians can strengthen the following areas:

• Awareness. Knowing which patients are more likely to struggle with SDOH is key to establishing trust. The AAFP’s Social Needs Screening Tool offers sample questions that can be included in an intake questionnaire to gauge the challenges patients encounter on a regular basis. But awareness extends beyond questionnaires. Providers need to consider the impact of outside events such as COVID or the escalation of racism on the communities they serve and how trauma might impact the ability for a patient to access care.
• Communication. No small complaint, or comment pertaining to SDOH should go unacknowledged. Physicians and other healthcare stakeholders should engage in more pointed follow-up to determine actual needs. Active listening can encourage a broader dialogue around SDOH and help care partners, such as social workers, connect patients to the most appropriate resources. The ‘Ask me 3” method is an excellent way to engage patients.
• Technology. EHRs need to support with care collaboration between multiple care partners in a patient’s ecosystem to ensure everyone is on the same page. They should also be customized to meet the practice’s informational needs, with care pathways that guide physicians in a new direction when needed. For example, if a patient answers the question, “do you have adequate transportation?” with “no,” the EHR should pre-populate other follow-up questions pertaining to transportation access.

With greater commitment to addressing SDOH, providers have an opportunity to engage their patients in new ways and improve their experience. And by leveraging more targeted communications tactics, coupled with smarter technology applications tailored to SDOH, providers are better equipped to improve outcomes and save lives.