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How should providers screen for social determinants of health?

The stats are alarming:

  • Up to 80% of health outcomes are not due to medical factors, but to a patient’s social and economic circumstances—such as their income, housing situation and even whether they own a car.
  • 68% of Americansare affected by at least one social determinant of health (SDOH).
  • Approximately 24% of hospitals and 16% of physician practices screen for food insecurity, housing instability, utility needs, transportation needs, and interpersonal violence—which means the majority don’t screen for all relevant social needs.

The healthcare industry has been talking about the importance of addressing social determinants of health for years, but many struggle with how to collect the insights. For example, if 68% of Americans are affected by at least one SDOH, how do they even discover the one? What is the ideal way for providers to screen for SDOH?

Should they simply ask the patient? Do they start a visit with a survey, probing for details that could ultimately impact care management decisions?

Providers know these sensitive topics – housing instability, financial instability, food insecurity and onward – can be tough and uncomfortable conversations. So, where to begin?

Should you rely on patient surveys to capture SDOH?

Patient surveys can be a useful way to find out about many potential barriers to care. However, they bring limitations:

  • Your insights will be limited to the patients who show up—so anyone who has struggled to attend an appointment (and therefore potentially with higher needs) will be left out
  • It can be time-consuming and expensive to give staff the time and space to conduct personal interviews
  • They rely on patients to be willing to share openly, but some may not feel comfortable doing so
  • There is room for error in how questions and answers are interpreted by both the survey team and respondents
  • Social circumstances can change over time, so it’s possible that the information gleaned in the survey may not be relevant a few months down the line.

Knowing SDOH can have such a huge impact on a patient’s health certainly means clinicians should discuss these topics in the exam room, but relying solely on patient surveys and conversations could lead to gaps in intel.

When should you screen for SDOH?

Screening for social needs when a patient first registers or engages with your services is a good starting point. But what happens when their situation changes between diagnosis and treatment? What if they disclose a social need to a specialist that wasn’t flagged on their initial intake form? Does your staff know how to discuss sensitive social issues? Can they create a safe space for patients to share? Have you got clear referral pathways when an issue is flagged?

Look for possible touchpoints in the patient’s journey where referrals to support services would be appropriate. Looping in the relevant primary care services is a good way to make sure your patients are connected to community-based programs and supported throughout their journey, whenever a new or changed social need is identified.

What types of data could offer the SDOH insights a provider needs?

Geographical and community-level data can help a healthcare organization understand their patient population’s income, housing situation and employment status. These are useful for population-level care planning but aren’t patient-specific.

A better way is to analyze securely collected consumer marketing data for more specific and accurate information.Working with a trusted data vendor that is a compiler of original-source consumer data can help you navigate your options.

The real predictive power of SDOH data comes when you combine patient-specific information obtained through screening, with consumer databases. A third-party vendor can help you access data on your patient population’s income, occupations, length of residence and other social and economic circumstances. Your care managers can use this to inform proactive, preventative conversations with patients to solve any non-clinical gaps in care.

Bottom line …

When healthcare organizations have a holistic view of patients—and the SDOH that play a role in their lives—they can take steps to help prevent avoidable hospital visits, emergency department (ED) utilization, appointment no-shows and worsened conditions by encouraging and facilitating earlier interventions.

The key is to start with the right data.