Hospitals, Physicians Aren’t Screening for Social Determinants of Health

Addressing social determinants of health has become the topic of the moment in health care.

Despite being a popular talking point and area of focus for home care agencies, many hospitals and physician practices aren’t screening for SDoH barriers. In fact, only 24% of hospitals and 16% of physician practices screen for recommended social determinants of health, according to a recent JAMA study.

“Despite the spotlight on the importance of social needs, there is little consensus about responsibility for addressing social needs or the best approaches to the problem,” researchers from Dartmouth University wrote in the study, published last month.

Broadly, social determinants of health are socioeconomic and environmental factors that impact differences in health status. They include, for example, housing instability, food insecurity and access to transportation.

As the U.S. health care system began putting a greater emphasis on value-based care, hospitals and physicians began focusing more on population health, whole-person health and addressing needs that fall outside of traditional clinical care.

Additionally, government policymakers and private payers began creating programs that attempted to integrate social services into clinical care, such as the Centers for Medicare & Medicaid Services’ (CMS’s) Accountable Health Community model.

One company that has prioritized social determinants of health is Denver-based startup DispatchHealth.

“I think we have realized how much social issues impact our overall health and, in turn, the cost of care,” Dr. Mark Prather, founder and CEO of DispatchHealth, told Home Health Care News.

DispatchHealth was founded in 2013 and works alongside in-home nursing care providers, offering mobile high-acuity services and urgent care in 16 markets across the U.S.

Even though experts say there is an increased awareness about the ways that socioeconomic and environmental factors influence health outcomes, only a small percentage of physician practices and hospitals are screening for all the ones recommended by the federal government.

One of the main reasons for this is oftentimes clinicians lack the resources to address social needs once they’ve been discovered, according to Dr. Prather.

For example: not being able to address the needs of patients who have transportation challenges, he said.

Another reason is that physician practices may not have the financial or staffing resources to

routinely screen for social determinants of health in the course of clinical care, according to the JAMA study.

The providers that are the exception when it comes to low screening rates are Medicaid accountable care organizations (ACOs), physician practices in Medicaid expansion states, federally qualified health centers, academic health centers, bundled payment participants and primary care improvement programs.

“The clinicians that are involved in value-based care reform are screening more,” Dr. Prather said. “That’s not a surprise to me, in that the totality of the cost of that care flows to those groups of providers, so they are much more interested in addressing those social needs because they understand how much that impacts cost of care. Until we get larger payment reform and value-based care reform, I worry that we won’t see an uptick in the screening.”

In general, the in-home care industry has taken an active role in addressing social determinants of health.

On the home care side, the broadened scope of the Medicare Advantage (MA) program has helped to bolster these efforts.

In April 2018, CMS first expanded the MA program, making way for home care providers to offer non-medical benefits and become partners in MA contracts.

Overall, MA beneficiaries are often affected by socioeconomic factors that have an impact on health. About 50% of dual-eligible patients reside in neighborhoods where the median income is lower than $30,000.

Further compounding matters, dual-eligibles are more likely to live in neighborhoods with higher rates of poverty and with less education, according to Avalere Health.

In June, Envoy America and HomeThrive partnered to create a program that offers transportation-plus-assistance and companionship services to older adults.

“Transportation is one of the biggest challenges that family members have,” Dave Jacobs, co-founder and managing director of HomeThrive, previously told HHCN. “So finding a great provider and partner in that was critical for us. Transportation is such a lynchpin to a lot of other social determinants.”

On the private-pay side, Alliance Homecare recently began offering food delivery through its partnership with Epicured, a subscription meal-delivery service.

“I know that food is medicine,” Greg Solometo, CEO and co-founder of Alliance, previously told HHCN. “There are absolutely ways that providing a better nutrition [experience] to our clients is going to yield better [health care] results.

New York-based Alliance provides short-term personal care, home health care and care management services in support of hospital or skilled nursing facility (SNF) discharges. The company also provides concierge services, which include long-term support, weekly care management, meal preparation, social engagement and more.
Meanwhile, major companies such as, Lyft, Uber and Ford have moved forward in setting up services and partnerships that address social need.