By Nick van Terheyden aka Dr Nick, Principal, ECG Management Consulting
Twitter: @drnic1
Host of Healthcare Upside Down – #HCupsidedown
Given the enormous amount of money we spend on doctors’ appointments, medications, tests, procedures, prevention activities, and the like, it would be reasonable to assume that healthcare plays an outsize role in our overall health. But by some estimates, medical care only contributes about 20% to our overall health and well-being.
The other 80%? Certainly our genetic makeup is a dominant factor. But our physical environment, health behaviors, socioeconomic status, and other circumstances—collectively, what we call social determinants of health (SDOH)—also play a significant role in our health outcomes.
The impact of SDOH extends to most aspects of our lives. According to the US Department of Health & Human Services’ Healthy People 2030 initiative, SDOH are “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” SDOH factors shed light on why people born a few miles away from one another can experience vast differences in life expectancy—in some cases, differences of up to 25 years.
In light of the profound impact of SDOH on people’s well-being and health, why do we not see more programs designed to address SDOH in communities?
“I think most healthcare organizations do really care about their patients in their community,” says says Veronica (Ronnie) Oestreicher, a principal at CSuite3. “But asking them to step out of the zone of what they’re used to doing is always something that takes time, structure, and a certain comfort level.”
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Healthcare organizations that are willing to step outside of that comfort zone can make a substantial difference in their communities. Health systems may not be able to resolve issues such as food insecurity or housing deprivation, but by learning more about their patients’ environments and facilitating connections with community resources, they can help put patients on a path to better health.
“When you’re working with your provider team, you want to be seen as an individual patient, looking at all the inputs in your life that could lead into health outcomes,” explains Salem Hawatmeh, a manager at ECG Management Consultants.
Coauthors of a recently published whitepaper titled “Operational Framework for Addressing Social Determinants of Health,” Salem and Ronnie want to give health systems a roadmap for understanding SDOH and enacting meaningful interventions. They argue that addressing SDOH can reduce overall healthcare spending, decrease hospital readmissions and unnecessary utilization, and achieve better health equity across populations.
Ronnie and Salem join me on this episode of Healthcare Upside Down. Here are three takeaways from our conversation.
Why healthcare organizations should focus on SDOH.
Serving in some capacity to mitigate SDOH is a natural step for most healthcare organizations, as it builds on their tradition of caring for the community. But as Ronnie explains, medical care only goes so far. “One of the most fascinating studies that I’ve seen on this topic is how much of our healthcare is influenced by factors other than healthcare services,” she says. “Socioeconomic factors, physical environment, health behaviors, and genetics account for about 80%. And that’s pretty shocking, when you think that only 20% is what we do in healthcare.”
To provide better care, organizations need to understand more about the other 80%—in particular, what factors might inhibit their patients from adhering to a care plan. For example, patients without reliable transportation may be unable to pick up prescriptions; food insecurity may prevent patients from maintaining a consistent and healthy diet.
“Healthcare organizations should see this as preventive care,” Salem says. “When we talk about upstream healthcare, it’s doing the well visits, but it’s also asking patients about things in their lives that make up the total patient. I see it as connecting two points with one another: point A, ask the question and get the answer about those social factors; point B, connect them to resources.”
Variation in SDOH data collection.
Healthcare organizations certainly aren’t oblivious to SDOH, and many do ask questions of their patients designed to learn more about their environments. “I think a lot of well visits capture parts of the social environment,” Salem says. But the queries need to be more comprehensive. “At my recent well visit, I recall being asked how often I drink, and if I smoke. Those do take into account some of the behavioral items, but it needs to be expanded—Do I have the right reliable transportation? Have I been missing appointments because of reasons that are not within my control?”
Ronnie notes that many organizations are stymied by the lack of a standard approach to collecting SDOH data. “There’s no consistency yet in the way we collect the data, and what data we collect,” she says. “It will be a positive development when there are standard questions that all can ask based on facts and evidence.” In the meantime, though, Ronnie suggests organizations seek out resources that will help them devise SDOH questionnaires. “I think every healthcare organization should be making sure that, even if they’re not consistent, they’re asking the questions.”
Rethinking ROI.
It’s an inevitable question posed by health system leaders, and a fair one—am I going to see a return on this? If health systems invest in capturing and coding SDOH data, or pursue more ambitious interventions in the community, what kind of return on investment (ROI) can they expect?
Both Salem and Ronnie cite evidence of how SDOH investments can benefit patients and the organizations that serve them. But it’s not simply a matter of dollars and cents. To be sure, hospitals stand to reduce readmissions by understanding the factors that are bringing them back to the hospital and helping them adhere to care plans. But Salem explains that we need to distinguish between a traditional, financial ROI and something harder to quantify—social ROI.
“There’s the internal organization impact on the organization and the patients themselves,” he says, “and then there’s the social or community benefit of this. Are you impacting your patients only, or are you put impacting the larger community that you’re a part of?”
“Social ROI is much, much harder to measure than typical ROI,” Ronnie acknowledges. “How do you impact your surrounding community, whether that’s crime reduction, or a better educated population? People who know more about cooking nutritious meals—how does that impact health? That’s much harder to calculate.”
But even from a bottom-line perspective, investing in SDOH is proving to show a financial return. Ronnie points to an affordable housing program run by Bon Secours in Maryland. “The social ROI of what they were trying to achieve in terms of helping adults have stable housing, better preventive healthcare services, less crime, and better nutrition showed that they could save $1.30 to $1.92 for every operating dollar that was spent.”
About the Show
The US spends more on healthcare per capita than any other country on the planet. So why don’t we have superior outcomes? Why haven’t the principles of capitalism prevailed? And why do American consumers have so much trouble accessing and paying for healthcare? Dive into these and other issues on Healthcare Upside/Down with ECG principal Dr. Nick van Terheyden and guest panelists as they discuss the upsides and downsides of healthcare in the US, and how to make the system work for everyone.
This article was originally published on the ECG Management Consulting blog and is republished here with permission.