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Addressing Social Determinants of Health Requires a Strategic Approach in an Evolving Healthcare Environment

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Increasing pressure on providers to assume accountability for meeting the goals of the Triple Aim has inspired a new focus on the social determinants of health.

According to the World Heath Organization, social determinants include the social, economic, and physical environment, as well as a person’s individual characteristics and behaviors. These determinants alone may explain as much as 70% of one’s health outcomes, creating a significant opportunity for stakeholders seeking to improve health.

Healthcare leaders have highlighted social determinants of health in multiple settings, including at conferences, in press releases, and in news articles. In 2018, for example, Kaiser Permanente launched a partnership called CityHealth to advanced policies that emphasize the health of communities. It is one of several arms of an overarching strategy to promote community health by addressing social issues such as housing stability, homelessness, and even workforce development.

As healthcare stakeholders explore the social determinants of health, become familiar with best practices for addressing unmet social needs, and consider how they can best engage in this topic, we recommend several strategic considerations before launching any initiatives. Engagement with social determinants of health can be enhanced significantly by pursuing a multi-pronged strategy that considers stakeholder partnerships, the role of evidence and data, patient and consumer engagement, and public policy addressing these important factors.

In 2020, Avalere’s Center for Healthcare Transformation will explore key developments and strategic opportunities in social determinants of health through Avalere Insights, covering the multi-dimensional strategy outlined below:

  1. Create Well-Aligned and Viable Stakeholder Engagement and Partnerships: A diverse array of stakeholders have recently explored partnerships focused on addressing social determinants of health and social care initiatives to address patient obstacles like transportation access. As interest in social determinants of health increases, new third-party entities, particularly those with data analytics capabilities, are springing forth to provide supportive services. These innovative partnerships require careful alignment of expectations and objectives to ensure mutual understanding and sustainability.
  2. Develop Robust Evidence Generation to Support Stakeholder Adoption: While the evidence for the impact of social determinants of health on health outcomes is consistent and extensive, research demonstrating how to effectively address these unique patient needs is still growing and evolving. Many stakeholders are seeking solutions to address unmet social needs but are looking to adopt tactics that have been vetted by peer review and that can demonstrate value. Given notable limitations in this type of evidence, those generating new solutions will need to have a robust and comprehensive evidence generation strategy to demonstrate the impact of their approaches to providers and communities. To support acceptability, sustainability, and scale, evidence will be a key factor in ultimately facilitating stakeholder support for social determinants of health initiative adoption.
  3. Design Solutions to Include Patient Engagement and Shared Decision Making: As consumerism grows and expectations of patient engagement continue to increase, provider organizations’ interest in addressing the social components of patient health will grow in tandem. For instance, it is well established that individual health behaviors are influenced by multiple social influences including culture, public policy, neighborhood factors, and family support. The evolution of the healthcare market toward a value-based system compounds the need to address patient engagement and shared decision making as accountability for patient outcomes and quality of care increases. The social determinants of health are a critical facet of patient engagement as these determinants can impose barriers to health and well-being.
  4. Be Proactive with Policymaker and Government Agency Positions on Social Determinants of Health and Their Impact: Both private and public payers have pivoted to social determinants of health as they continue their emphasis on the Triple Aim of healthcare. Policies are being developed to incentivize and support providers in addressing patients’ social care needs and ultimately social determinants of health. In 2019, for example, CMS announced the availability of several tools to better measure and respond to patients’ social needs. Private payers have also staked out a role for themselves in addressing unmet social needs and are even beginning to address social determinants of health. Humana launched an initiative to address unmet social needs with the goal of increasing the number of “healthy days” in its members by addressing social needs such as food insecurity and social isolation. Healthcare systems are joining forces to address the needs of patients experiencing the worst disparities and policymakers are listening. In 2019, the US House of Representatives voted on legislation to introduce a Social Determinants Accelerator Program addressing the social needs and well-being of Medicaid patients.

In 2020, the focus on social determinants of health will accelerate. As the issue becomes part of the mainstream healthcare conversation, additional stakeholders will be seeking to engage and pursue partnerships to implement social determinants of health initiatives. Stakeholders who plan accordingly and consider a strategic approach for how to enter this space with these steps in mind will be more likely to succeed in the fast-evolving market that is the US healthcare system.

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