Analysis: Prevalence of screening for SDOH by U.S. physician practices and hospitals

• A recent JAMA study concluded that  24% of hospitals and 16% of physician practices are screening for all five key SDOH needs.
• CMS identified the key risks, which include food and housing instability, to be part of their Accountable Health Communities Model.
• SDOH issues are the focus of this year’s HFMA Thought Leadership Retreat Oct. 3 and Oct. 4.

A recent JAMA study investigates how often hospitals and physician groups are screening patients for social determinants of health (SDOH) — those factors that impact health outcomes and not traditionally addressed by the health system.

5 key SDOH needs

SDOH, which providers are now becoming more accountable for under value based payment models, have recently become an area of focus in the provider community due to their impact on health outcomes and cost.  This study determined screening rates of five key social health needs as follows:

• Food
• Housing instability
• Utility needs
• Transportation needs
• Interpersonal violence

These five SDOH were chosen as these are the needs CMS identified to be part of their Accountable Health Communities Model, an innovation payment model that connects clinical delivery sites to community resources to improve outcomes and lower costs of care.

The study concluded that 24% of hospitals and 16% of physician practices are screening for all five needs, and those facilities that are doing better at this tend to be Federally Qualified Health Center (FQHC) and Academic Medical Centers, and those providers in bundled or primary care improvement models, and serving more economically disadvantaged patient populations.

Takeaway

I don’t find it surprising that hospitals and physician groups aren’t screening their patients at high rates for their social needs. SDOH, the conditions in which people are born, grow, work, live and age, have long been understood.  In fact, my alma mater was named after the founder of the social work profession in the United States in the late 1800s, Jane Addams, who can be credited for cleaning up the poor sanitation system in Chicago, saving many lives from the spread of disease. 

The reason health systems haven’t addressed SDOH well in the past is that there hasn’t been a funding model that supports it.  And now that health systems and physicians need to be more accountable for outcomes, they are looking more broadly at what impacts a person’s health, finding that mostly it’s not healthcare.

Who is responsible for addressing SDOH risks?

The challenge for hospitals and physicians that arises when screening patients is: If social risks are identified, whose responsibility is it to address those risks, and what resources are available?

I would argue that physicians don’t have the training, resources or time to address all of patients’ social, psychological and environmental needs, but they could refer patients to clinicians and resources more equipped to provide social interventions. The challenge then is making those connections.

SDOH is topic of HFMA Thought Leadership Retreat

This year’s HFMA Thought Leadership Retreat Oct. 3 and Oct. 4 is focused on SDOH issues and features a great line up of experts who are tackling this issue.

I look forward to our cross-stakeholder discussions where we will explore: How to better address SDOH through the health system, discuss data and technology needs and strategize on effective funding models.