Social determinants of health ROI challenges are not yet outweighing potential benefits to patients

• More providers are approaching patient care more holistically by considering not only patients’ medical conditions, but other factors that impact patient health, including social determinants of health (SDOH),  such as nutrition, housing and transportation.
• Despite the increased focus on SDOH, even the most progressive health systems find it challenging to address it, according to a recent Modern Healthcare article.
• With the continued shift to value-based care, commitments to SDOH will continue and grow, according to HFMA’s Katie Gilfillan.

As the U.S. health system continues to shift to value-based and population-based payment models, providers are approaching patient care more holistically — considering not only patients’ medical conditions, but other factors that impact patient health — including social determinants of health (SDOH), such as nutrition, housing and transportation.

However, even the most progressive health systems find addressing SDOH challenging, according to a recent Modern Healthcare article. The article highlights the struggle healthcare providers have going beyond screening for social risk factors. While many have implemented a process to identify patients with challenges related to food security, housing, finances or transportation; less prevalent are the steps required to go beyond screening, such as building an adequate referral network, sufficient workforce and IT systems for tracking and evaluation.

Evaluating SDOH ROI challenges

Even for organizations that have robust intervention systems in place, evaluating the effectiveness and ROI proves challenging. A recent study published in NEJM on healthcare hotspotting, failed to show effectiveness of an intervention targeting superutilizers. The study targeted the top 0.5% of the patient population that accounted for 11% of the city’s hospital expenditures.

Patients in the study were on five or more medications, lacked social support,  had been diagnosed with a mental health condition, and experiencing an active drug habit and homelessness. Half of the patients received an intervention of intensive clinical and social support. The non-intervention group received post-discharge care, which was unmeasured. The study primarily looked at readmissions within 180 days after hospital discharge.

Analysis showed no significant difference in readmissions between the control group and intervention group. However, the study highlighted the challenges with implementing effective interventions. For example, follow-up home and provider visits were required, but given the patients were homeless and unlikely to have a telephone, this was achieved in less than 30% of patients. 

Takeaway

Addressing social risk issues is challenging and complex. Patient needs are complex, and as with medical care, generally there isn’t a one-size-fits-all solution. Despite these challenges, there are plenty of examples of programs where interventions for SDOH are effective in addressing social risk issues.

In fact, health systems recognize the need to address patient care more holistically and are making the investments in SDOH — nearing $2.5 billion over the past two years. It is likely, with the continued shift to value-based care, these commitments will continue and grow.