SDOH: An Emerging Priority for Healthcare
The World Health Organization has defined social determinants of health as the range of nonmedical factors that influence health outcomes: “They are the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life.”
The U.S. Department of Health and Human Services groups SDOH into five domains: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. Specific social determinants include such things as safe housing and transportation, air and water quality, job opportunities and systemic discrimination.
A 2015 study in the American Journal of Preventive Medicine concluded that SDOH accounted for 84 percent of health outcomes, with medical factors accounting for just 16 percent. McKinsey estimated that individuals with unmet needs associated with SDOH are more likely to report higher healthcare utilization as well as poor physical and mental health.
HHS has prioritized SDOH as one of the five goals of its Healthy People 2030 initiative. Providers also recognize the importance of addressing SDOH, whether the motivation is driven by a mission to improve outcomes or by a more pragmatic desire to meet regulatory guidelines such as readmission reduction.
“When healthcare organizations look at health equity, they find out there are disparities and then there’s an obligation to act,” says Andrea Green, director of healthcare strategy for SDOH at LexisNexis Risk Solutions.
However, taking action can pose a challenge for three related reasons: SDOH data is difficult to collect; analytics efforts need a clear focus; and organizations need to provide business insights to both clinical and operational leadership.
“Even if you’re able to pool the data, the challenge is discerning actionable intelligence,” says Catherine Robison, health innovation scientist with Oracle Health. “The question becomes, what action can I take that maximizes patient outcomes while controlling costs, and what’s within my ability to influence?”
Here’s what organizations can do to better use data and technology to position themselves for SDOH success.
1. Standardize SDOH Data Collection Across the Organization
Organizations cannot address SDOH at an individual or population level without knowing where inequity exists. This information often resides in several places: patient intake forms, clinical notes, discharge summaries and call center notes, to name a few.
Wherever possible, organizations should standardize the way data is collected and expressed. “You need standards and definitions, and they need to apply across the board,” Racine says. “Nearly everyone can do something with the data. Their use cases may be different, but the definitions need to be the same.”
Two existing sets of standards can help organizations do this. One is the use of Z codes, a set of International Classification of Diseases codes that document SDOH needs such as unstable housing or problems with a relationship with a partner. Z codes aren’t required for billing purposes, and they’re used infrequently — the Centers for Medicare & Medicaid Services (CMS) reported that Z codes have been captured for just 1.6 percent of Medicare beneficiaries — but they represent a codified way to document unmet needs.
The other is a set of new quality measures for health plans under the Healthcare Effectiveness Data and Information Set. One set is tied to screening of and intervention for members with unmet food, housing and transportation needs. Another is linked to race and ethnicity stratification for certain existing HEDIS measures.
Green says leveraging these standards and mandates can provide a “more complete picture” of socioeconomic barriers that exist and how they may impact care quality.
Racine agrees, adding that standards-based processes have the additional benefit of creating a “sound data culture” throughout an organization. “Think about existing processes that no one bats an eye about,” he says, whether it’s the ethical practice of medicine or computers automatically logging off a user due to inactivity. “That’s where we should be with SDOH data collection.”
2. Provide Robust Analysis of SDOH Data That Addresses a Clear Need
The goal of any analytics initiative is to link disparate pieces of information to tell a more complete story and determine a certain course of action. The best way to do that with SDOH is to start with the end in mind, Green says.
“You need to determine the needle you want to move and then work backwards — figure out the pathway and the types of data you might need,” she says. This is important, as organizations may need to augment internal data with external data sources (such as consumer financial data), and there’s a cost associated with acquiring it and harmonizing it so that it’s consistent with existing data sets. “No one has unlimited resources, so it’s best to identify the biggest impact and deploy the resources there.”