Industry Research Says Providers, Plans Not Doing Enough to Address the SDoH

Two recent studies indicate more can be done by providers and payers.

The healthcare industry continues to devote ample attention to the social determinants of health (SDoH). A minimum of two studies on the topic appear weekly, each yielding the same compelling arguments:

  1. Healthcare organizations, providers, and stakeholders could do more to address social needs; and
  2. If the SDoH are not addressed, care costs will spiral out of control. It’s hard to imagine a price point beyond the current annual national health expenditures of $3.5 trillion.

 

The loud industry gasp some may have heard last week involved a survey conducted by the Urban Institute and Robert Wood Johnson Foundation. The survey was based on interviews with the five major Medicare Advantage (MA) insurers, which cover approximately 35 percent of the total.  

While the Centers for Medicare & Medicaid Services (CMS) released new policies last April allowing the MA plans to expand coverage of non-clinical services (e.g., meals, transportation, home cleaning services, etc.) that could enhance health conditions, few plans did so. The bottom line is clear: far more is expected of the MA plans to address the SDoH.

The gasp continued in response to Dartmouth University Study, and a story that quickly hit a number of news outlets: a majority of healthcare providers and physician practices are not adequately screening for the SDoH. According to researchers at Dartmouth University, 2,333 physician practices and 757 hospitals were surveyed from June 2017 to August 2018, and the following was found:

  • The good news: most U.S. physician practices and hospitals screen for at least one social need.
  • The concerning news: only 24 percent of hospitals and 16 percent of physician practices screened for all five social needs prioritized by CMS under its accountable health communities’ model. These include:
    • Food insecurity;
    • Housing instability;
    • Utility needs;
    • Transportation needs; and
    • Interpersonal violence (also the most commonly screened need identified)

With just about every entity across the industry investing extensive human and physical capital to address the SDoH, the Dartmouth research was a reminder that more could be done. The results put many healthcare organizations and providers on the defense.

The sites with the highest screening rates included those that traditionally screen populations viewed as more disadvantaged and at risk of the social determinants:

  • Federally qualified health centers;
  • Academic health centers;
  • Bundled payment participants;
  • Primary care improvement programs;
  • Medicaid accountable care organizations; and
  • Physician practices in those states with Medicaid expansion.

The reasons identified for limited screening varied, though lack of assessment tools should not have been one. While there is no consistent tool used across the industry, a number are in operation:

Other evolving models account for a “whole person” or more comprehensive view of a patient’s health. Contra Costa Health Services worked with EPIC and QLIK to develop an assessment, screening tools, and dashboards for social needs. The tools have been incorporated into an interactive care plan used by their case managers, who screen over 14,400 patients monthly. NCCare360 is the first statewide coordinated care network to electronically connect persons at risk of (or dealing with) the SDoH to community resources. The network is partnering with community providers, plus health and behavioral health organizations, to ensure that clients receive the care they need. Programs of this nature serve as models for other healthcare organizations and providers of creative wholistic programming in response to assessing and addressing all five domains of the SDoH.

The barriers identified for screening patients sounded familiar: lack of financial resources, time, or other factors. Proactive efforts beat reactive responses every time, and that extends to the social determinants. Appropriate assessment of patients’ social needs will take more investment of human and financial capital on the front end, yet these efforts consistently yield significant savings, not to mention organizational sustainability, on the back end.

This week’s Monitor Mondays Listeners Survey provided its own affirmation for the industry to make sure the SDoH are on their radar. The survey question asked:

Of the 5 social needs posed by CMS, how many does your organization routinely screen patients for (e.g., food insecurity, housing instability, utility needs, transportation needs, and interpersonal violence)?

{advpoll id=’103′ view_result=’1′ width=’0′ position=’center’}

As you can see, option D received the most votes, which was unfortunately not surprising. Like many hot topics in healthcare, the SDoH may be on everyone’s to-do list, but exactly to what degree remains the pivotal question. The SDoH should be on everyone’s radar in every organization, independent of their role. Each person, professional, provider, and practice setting has a unique part to play in appropriately assessing and addressing the social needs of their patients and populations.

Programming Note: 

Follow this continuing story weekly on Monitor Mondays, 10-10:30 a.m. EST, for the State of the Social Determinants report.

Facebook
Twitter
LinkedIn

Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP

Ellen Fink-Samnick is an award-winning healthcare industry expert. She is the esteemed author of books, articles, white papers, and knowledge products. A subject matter expert on the Social Determinants of Health, her latest books, The Essential Guide to Interprofessional Ethics for Healthcare Case Management and Social Determinants of Health: Case Management’s Next Frontier (with foreword by Dr. Ronald Hirsch), are published through HCPro. She is a panelist on Monitor Mondays, frequent contributor to Talk Ten Tuesdays, and member of the RACmonitor Editorial Board.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

2026 IPPS Masterclass 3: Master MS-DRG Shifts and NTAPs

2026 IPPS Masterclass Day 3: MS-DRG Shifts and NTAPs

This third session in our 2026 IPPS Masterclass will feature a review of FY26 changes to the MS-DRG methodology and new technology add-on payments (NTAPs), presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.

August 14, 2025
2026 IPPS Masterclass Day 2: Master ICD-10-PCS Changes

2026 IPPS Masterclass Day 2: Master ICD-10-PCS Changes

This second session in our 2026 IPPS Masterclass will feature a review the FY26 changes to ICD-10-PCS codes. This information will be presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.

August 13, 2025
2026 IPPS Masterclass 1: Master ICD-10-CM Changes

2026 IPPS Masterclass Day 1: Master ICD-10-CM Changes

This first session in our 2026 IPPS Masterclass will feature an in-depth explanation of FY26 changes to ICD-10-CM codes and guidelines, CCs/MCCs, and revisions to the MCE, presented by presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.

August 12, 2025

Trending News

Featured Webcasts

The Two-Midnight Rule: New Challenges, Proven Strategies

The Two-Midnight Rule: New Challenges, Proven Strategies

RACmonitor is proud to welcome back Dr. Ronald Hirsch, one of his most requested webcasts. In this highly anticipated session, Dr. Hirsch will break down the complex Two Midnight Rule Medicare regulations, translating them into clear, actionable guidance. He’ll walk you through the basics of the rule, offer expert interpretation, and apply the rule to real-world clinical scenarios—so you leave with greater clarity, confidence, and the tools to ensure compliance.

June 19, 2025
Open Door Forum Webcast Series

Open Door Forum Webcast Series

Bring your questions and join the conversation during this open forum series, live every Wednesday at 10 a.m. EST from June 11–July 30. Hosted by Chuck Buck, these fast-paced 30-minute sessions connect you directly with top healthcare experts tackling today’s most urgent compliance and policy issues.

June 11, 2025
Open Door Forum: The Changing Face of Addiction: Coding, Compliance & Care

Open Door Forum: The Changing Face of Addiction: Coding, Compliance & Care

Substance abuse is everywhere. It’s a complicated diagnosis with wide-ranging implications well beyond acute care. The face of addiction continues to change so it’s important to remember not just the addict but the spectrum of extended victims and the other social determinants and legal ramifications. Join John K. Hall, MD, JD, MBA, FCLM, FRCPC, for a critical Q&A on navigating substance abuse in 2025.  Register today and be a part of the conversation!

July 16, 2025

Trending News

Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24