How Providers Can Use Social Determinants of Health to Improve Patient Care

When Louisiana established its Permanent Supportive Housing program in 2008 to help reduce homelessness and unnecessary institutionalization, an independent analysis found something startling. For all of the people housed under this program, Medicaid acute-care costs fell by an average of 24% over time.1

In other words, regardless of the specific medical conditions of these individuals, or what treatments they might have been receiving while living on the streets, the act of providing them with a permanent home—all by itself—significantly reduced their future needs for hospitalization and other urgent medical interventions.

This is one of many examples of a phenomenon known as the Social Determinants of Health (SDOH), which the CDC defines as: “Conditions in the places where people live, learn, work, and play that affect a wide range of health risks and outcomes.”

The medical community has historically focused narrowly on its existing menu of clinical-care options to treat various illnesses and injuries, regardless of the unique circumstances of each patient’s life. But a growing body of data is showing that these social factors play an enormously important role in patient health outcomes and should factor into how a provider handles the coordination of care.

In fact, a national study by County Health Rankings found that only 20% of the modifiable determinants of a patient’s health are due to clinical care.2 As for the remaining 80%:

  • 40% are due to social and economic factors
    (education level, income, access to healthy foods)
  • 30% are due to health behaviors of the patient
    (calorie-consumption levels, alcohol and drug use, exercise)
  • 10% are due to physical environmental factors
    (neighborhood safety, air and water quality, healthy home life)

Yes, SDOH Data Is “Health Data”

The key takeaway from these research findings is that relevant social, economic, and environmental data points should all be deemed “health data” when evaluating a patient’s life circumstances and health risks—just as the provider would analyze that patient’s personal genetic profile or longitudinal medical record.

But the next question, of course, is how healthcare professionals can access and review all of the relevant social factors when developing a treatment strategy for a new patient. After all, lack of digital interoperability and effective data-sharing technologies make it difficult today for health providers to access even standard patient information—such as an individual’s medication history—in a reliable and timely manner.

Fortunately, we live in the digital era, and much of this SDOH data already exists in the cloud.

The Cloud Can Help Providers Access SDOH

The data representing the social determinants that can affect a patient’s health—and should affect how providers treat them—can be captured and shared through a number of tools already in widespread use today:

  • Consumer-facing technology applications
  • Patient document-exchange platforms (such as EHRs)
  • Health Information Exchange networks (such as CommonWell and Carequality)
  • Direct messaging among healthcare providers
  • Digital cloud fax technology

Having immediate and reliable access to these data points—and the ability to share them easily and in real-time with other healthcare entities—can help a provider tailor more relevant and effective care to each patient.

How Providers Will Need to Handle SDOH Data

But it’s important to keep in mind that if the medical profession begins to treat these social factors as “health information,” it will need to handle this data with as much care and sensitivity as it does ePHI and all other regulated patient information. That means healthcare providers should build at least two steps into their plans for applying SDOH to patient care:

1. It should require patient opt-in.

We believe we’ve made a strong case in this post for physician practices, hospitals, and other healthcare organizations to access and analyze the socioeconomic details of a patient’s life when building a strategy for that individual’s care.

But because these are highly personal and sensitive details, we also believe this should be an opt-in process, where patients are made aware that the care team will be examining their life’s details to make treatment decisions—and they agree to this plan.

2. It will need to be as secure as any other HIPAA-regulated data.

Because the healthcare provider will be reviewing, analyzing, and storing this SDOH data digitally (on an EHR or elsewhere in its digital environment), the provider must apply the same protocols for privacy and security as it does for all other ePHI the organization is responsible for protecting under HIPAA and other patient-privacy laws.

Applying SDOH Data in Healthcare Will Take Time—But it Will Be Worth the Effort

A growing body of scientific evidence indicates that Social Determinants of Health data will play a key role in helping providers improve care coordination and patient outcomes. It’s important to note, however, that because the medical community has only begun to integrate these data points into its care models, this process will take time.

But we’re confident that cloud applications, system-agnostic technology tools, and digital interoperability can all play a role in pushing the healthcare industry toward the streamlined sharing of social determinants data.

References:

1. Beyond Healthcare: The Role of Social Determinants in Promoting Health and Health Equality (Kaiser Family Foundation)

2. County Health Rankings: Relationships Between Determinant Factors and Health Outcomes (CHR)