Screening for social determinants of health (SDoH)

The Medical Group Managemt Association's most recent MGMA Stat poll asked healthcare leaders if they screen patients for social determinants of health. The majority (52%) responded "yes", 36% responded "no" and the remaining 12% reported they were "unsure."

Respondents who answered “yes” were then asked to select the social determinants of health prioritized by their organization. Many respondents cited multiple areas of focus, including:
 

• Food (28%)
• Transportation (27%)
• Housing (22%)
• Literacy (14%)
• Other (9%)

This poll was conducted on April 2, 2019, with 1,018 applicable responses.

The World Health Organization defines social determinants of health (SDoH) as, “the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.” On a global scale, they help explain differences in health outcomes between countries, but healthcare leaders increasingly recognize these factors as being measurable and relevant to the outcomes of individual patients. 

As providers embrace population health management, being able to build relationships within the community to refer patients to community service providers — such as emergency housing, literacy education, transportation and more — can improve those patients’ ability to make regular appointments, understand their care plans and adhere to prescriptions.

At Massachusetts General Hospital in Boston, building an SDoH survey for Medicaid patients to fill out helped identify areas where patients might struggle with their overall care. According to Mary Neagle, MSW, program director, primary care ACO strategy, Mass General, the survey screening created “a more comprehensive, cohesive model” for primary care providers across 26 adult and pediatric practices.

To provide this level of patient-centered care, practice leaders also must consider how incorporating SDoH screenings will affect practice operations and the bottom line. Having the financial basis to sustain the work is vital, though the ongoing shift toward value-based care should lead practices to align demonstrable outcomes of an SDoH program with reimbursement for delivery of higher-quality care.

As your organization is considering a SDoH program consider these common barriers:
 

•  Physician training may not include awareness of social resources
•  Standard 15-minute appointments do not offer time to screen for SDoH
•  The front desk may be too busy to add SDoH work to their responsibilities
•  SDoH survey administration requires clear ownership and accountability in an organization
• Integration of patient information is required in an EHR workflow

 

MGMA Stat is a national poll that addresses practice management issues, the impact of new legislation and related topics. Participation is open to all healthcare leaders. Results of other polls and information on how to participate in MGMA Stat are available at: http://www.mgma.com/stat

Sources

• “About Social Determinants of Health” (World Health Organization)
• “Social determinants of health in an ACO for better population health” (MGMA)

Stefan v. Jarmusz
Project Analyst
MGMA