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.

Print Friendly, PDF & Email
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

Remain Compliant – and Take the Money

Remain Compliant – and Take the Money

Our first topic today is local coverage determinations (LCDs) and variation. I have written in the past about national and local coverage determinations, and I

Read More

Leave a Reply

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

Featured Webcasts

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Frank Cohen shows you how to leverage the Comprehensive Error Rate Testing Program (CERT) to create your own internal coding and billing risk assessment plan, including granular identification of risk areas and prioritizing audit tasks and functions resulting in decreased claim submission errors, reduced risk of audit-related damages, and a smoother, more efficient reimbursement process from Medicare.

April 9, 2024
2024 Observation Services Billing: How to Get It Right

2024 Observation Services Billing: How to Get It Right

Dr. Ronald Hirsch presents an essential “A to Z” review of Observation, including proper use for Medicare, Medicare Advantage, and commercial payers. He addresses the correct use of Observation in medical patients and surgical patients, and how to deal with the billing of unnecessary Observation services, professional fee billing, and more.

March 21, 2024
Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Explore the top-10 federal audit targets for 2024 in our webcast, “Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets,” featuring Certified Compliance Officer Michael G. Calahan, PA, MBA. Gain insights and best practices to proactively address risks, enhance compliance, and ensure financial well-being for your healthcare facility or practice. Join us for a comprehensive guide to successfully navigating the federal audit landscape.

February 22, 2024
Mastering Healthcare Refunds: Navigating Compliance with Confidence

Mastering Healthcare Refunds: Navigating Compliance with Confidence

Join healthcare attorney David Glaser, as he debunks refund myths, clarifies compliance essentials, and empowers healthcare professionals to safeguard facility finances. Uncover the secrets behind when to refund and why it matters. Don’t miss this crucial insight into strategic refund management.

February 29, 2024
2024 SDoH Update: Navigating Coding and Screening Assessment

2024 SDoH Update: Navigating Coding and Screening Assessment

Happy World Health Day! Our exclusive webcast is just $99 for a limited time! Use code WorldHealth24 at checkout before April 12th to claim this discount.

Dive deep into the world of Social Determinants of Health (SDoH) coding with our comprehensive webcast. Explore the latest OPPS codes for 2024, understand SDoH assessments, and discover effective strategies for integrating coding seamlessly into healthcare practices. Gain invaluable insights and practical knowledge to navigate the complexities of SDoH coding confidently. Join us to unlock the potential of coding in promoting holistic patient care.

May 22, 2024
2024 ICD-10-CM/PCS Coding Clinic Update Webcast Series

2024 ICD-10-CM/PCS Coding Clinic Update Webcast Series

HIM coding expert, Kay Piper, RHIA, CDIP, CCS, reviews the guidance and updates coders and CDIs on important information in each of the AHA’s 2024 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.

April 15, 2024

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 →

Happy World Health Day! Our exclusive webcast, ‘2024 SDoH Update: Navigating Coding and Screening Assessment,’  is just $99 for a limited time! Use code WorldHealth24 at checkout.

SPRING INTO SAVINGS! Get 21% OFF during our exclusive two-day sale starting 3/21/2024. Use SPRING24 at checkout to claim this offer. Click here to learn more →