Social Determinants of Health Opportunities: In Practice and In Policy

Social determinants of health (1) as a measurement of a person’s, or a population’s, overall health emerged in the last decades of the 20th century and have now become a recognized metric in US healthcare delivery.


In the still-ongoing process of improving the overall access and quality levels in American healthcare, social determinants, or SDoH, have started to impact policy, payment models, and community engagement in the healthcare system.


Is there an opportunity for healthcare providers and facilities to both improve overall health and build sustainable revenue while addressing their community’s social determinants of health issues?


Any hospital that’s working to manage the impact of social determinants on the community they serve will see that impact in their clinics, and on their wards. Figuring out how to address them outside their facility walls will take time, and effort.


Advocating for policy changes on the state and federal levels that make social determinants part of core care models, including reimbursements for social services “prescriptions” like housing and healthy food, is another area with long-term payoffs.


When the Centers for Medicare & Medicaid Services (CMS) started incorporating the use of Medicaid 1115 waivers in demonstration projects that provide wraparound services to address social determinants (2), paying directly for housing costs has been excluded, but state programs that use community health workers to help patients address social issues that impact their health have seen success in states like Illinois (3).


Talking about social determinants of health can start to unpack a community’s feelings about income inequality, economic opportunity, and inequality in general, which feels high-risk when the conversations kick off.


One opportunity for a hospital in that community would be to start the social determinants conversation with a community health snapshot, using the data the hospital has on one or two prevalent local health conditions, like hypertension or diabetes.


The conversation can get started with dialogue such as the following:


“Did you know that high blood pressure is the silent killer? We can help,”


“Diabetes is preventable. Ask us how,”


These questions, along with the stats on hypertension and diabetes in the community, would be a solid opening move.


Health plans, clinics and hospitals, can then employ some right-now ways to address the impact of social determinants on facilities, while also helping to address the right-now needs of the people in the community.


Making certain that the patients cared for in a clinic or hospital know what coverage they’re eligible for is a critical success factor, for both the provider and the patient.


Working with a program like PremiumAssistTM(4) for dual-eligible (Medicare and Medicaid) patients.


Achieving good HEDIS quality scoring along with a full eligibility enrollment snapshot (5) on the individual patient and patient population level can accelerate a hospital’s quality measurement score, while ensuring full reimbursement and addressing population-level social determinant issues.


Working both sides of the social determinants of health impact zone – on the patient and community level, with the direct impact on human health; and on the provider level, to ensure quality of care, effectiveness, and sustainability for the clinics and hospitals that serve the community – will require both short-term and long-term strategies and planning to implement those strategies.


In the Short Term


Conduct outreach in the community to start conversations.

Discover what matters to the people your clinic or hospital serves

What social determinants are having the most impact on their lives, from their perspective.


You can then match up your population health data – the conditions and illnesses that are most prevalent – with the social determinants data provided directly from your community, and mapping of your community from sources like the Centers for Disease Control (6). Match this effort with programs like PremiumAssistTM(7), and Centauri Insights©(R)(8).


Earning your community’s trust, and driving community loyalty to your clinic or hospital, requires more than just being there when someone gets sick. Building a sense of community, with your services seen as the healthy hub of a healthy community, starts with digging in on the social determinants of health affecting that community.


If you need help with that – let us know (9)!