The conditions in which people are born, grow, live, work and age are known as their social determinants of health. These circumstances of their lives are affected by the division of money, and other resources at the global, national and local levels. Social determinants are primarily responsible for health inequities. It is what creates the unjust and needless differences in health status within and between countries.
More studies are now being conducted to seriously study the impact of social determinants of health (SDOH or SDH) as managing these is crucial for improved health care outcomes such as better public health closed care gaps and lower costs. Reena Pande, MD, the chief medical officer at AbleTo says, “If you don’t address the behavioral health of patients, you can’t address the rest.”
The 5 Major Social Determinants of Health
Though there are many social determinants of health, they can be grouped into five main categories:
1. Economic Instability: Poverty, unemployment, food insecurity, housing instability etc. can easily leave a person economically unstable. Such a person ends up having numerous health-related issues.
2. Educational concerns: High school graduation, Enrollment in higher education, Language and literacy, Early childhood education and development etc. cannot be avoided while considering the physical and mental well being of an individual.
3. Social and Community Background: Social cohesion, Civic non - participation, Discrimination, etc. can affect a person’s health physically and mentally.
4. Health and Healthcare: Accessibility to health care, Accessibility to primary care and Health literacy among individuals is also a governing factor.
5. The living area and Environment around: Availability of healthy foods, Quality of housing, Crime and violence around, environmental conditions
Summing up, the social determinants of health have an important role in an individual’s health care as it depends upon the availability and accessibility of healthcare. Care teams also cannot exclude the emotional blockers such as behavioral, stress, depression, bereavement, and caregiving challenges the patients may be facing.
The ultimate success of a value-based healthcare system relies on factoring in the social determinants into the healthcare equation. Michael Millenson, president of Health Quality Advisors says, “You can’t get where you want to go without patients going there with you”. Incorporation of behavioral health into mainstream healthcare is a promising patient intervention, as such behavioral issues are a major determinant of health care costs. So treating people holistically is what gaining momentum.
Though physical ailments continue playing a major role in a person’s life, considering and dealing with the patient’s psychological barriers will do wonders for their healing. This approach to public health care has lasting impacts. Though plenty of research is being conducted on this topic, it's not as simple as it sounds and cannot be achieved overnight. Understanding more about social determinants will definitely pave the way for better patient engagement, as caregivers get a clearer sense of direction and sight on where to go and how to go about it.
3 Reasons why Social Determinants of Health is the future of Value-based Care
Social determinants of health govern the future of the value-based care because they promise:
1. Improved Health Outcomes
The lack of knowledge, as well as the access to necessary resources can affect the public health of a population adversely. A patient with financial struggles will find it difficult to pay for the required medical consultations as well as the medications. Someone who is unable to access reliable transportation for follow-up doctor appointments ends up missing it. A patient who manages by himself without any in-home assistance also may suffer a setback if there is no one to verify that he/she is eating sufficiently and having the prescribed medications properly. In all these the cases, there is higher risk of readmission and the standard healthcare plans fail. When there is improved patient-provider communication, then the care provider is able to get a better grasp of such obstacles.
In a value-based healthcare system, the providers are able to identify these type of at-risk patients. Then they can intervene in the situations at the right time to provide solutions that satisfy not only the individual’s specific needs. This also increases the likelihood of a more positive outcome. Obviously, it is the concern about the impact of social determinants of health that has helped to yield the improved public health status in such cases.
2. Reduced Care Gaps
A care manager to simply review the patient’s discharge summary and current medical records to easily get an idea of his health status. But to accurately assess an individual’s 30-day readmission risk - or the risk of an adverse event - providers need to think beyond this summary of the patient’s medical treatments. Analyzing the patient-specific social determinants of health data is the key here because it can predict the impactability of the care services. The use of analytics clubbed with the knowledge of social determinants help the care providers to learn that an expensive home visit can be replaced by a less expensive timely follow-up call for a patient who is living alone.
Preventive care is also an important part of healthcare. A value-focused organization in Minnesota enrolled its patients in a ‘Social Determinants’ program with an aim was to increase preventive care and reduce preventable hospital admissions for vulnerable patients. Various care coordination models were used to address a patient's’ physical, behavioral, social and economic needs. ED visits were decreased by 9.1% and outpatient visits increased by 3.3% within a year of implementing the program. Needless to say that addressing and treating only the diseases without taking into account its root cause will not yield the desired health results.
3. The Financial Success
The success of any model depends on its cost-effectiveness or the revenue it generates. The rule is applicable to value-based care models as well. The care providers should have an insight into the general well being and the health status of the patient population they have undertaken. The care providers can be penalized otherwise. For example, they are at risk if a patient is readmitted to the hospital within 30 days of discharge. This will affect the overall costs negatively. For value-based care to have a real impact, the care providers must take corrective and precautionary measures to deal with the social determinants of health.
Incorporating the social determinants of health into the healthcare framework can leverage the complete picture to a much higher level. Figuring out the major causes behind a population’s illness can lead to more effective solutions in restoring their health. Social determinants make it easier to recognize the value of socio-economic conditions and states that they are essential in staying healthy.
Technological prowess has helped substantially to deal with the increasing population and to find out innovative solutions that deliver better clinical results. Healthcare sector is changing rapidly and future-readiness is what’s going to create the required impact and momentum. Understanding and overcome social determinants of health create the foundation for preventive care. So focusing on it means a big win for everyone involved in the healthcare industry.