1 in 5 patients at high risk of socioeconomic health problem, survey finds
- A study of 500 random patients found that 68% suffer with at least one social determinant of health (SDoH) challenge, with 57% having moderate-to-high risk in at least one of the following categories: financial insecurity, social isolation, housing insecurity, addiction, transportation access, food insecurity and health literacy.
- Though Medicare and Medicaid beneficiaries made up 39% of respondents, they have the largest high-stress share. Nearly 60% have moderate-high stress in at least one category, according to healthcare tech firm Waystar, with 33% having high stress in three or more. Those with high-stress are more likely to suffer from chronic conditions, which are more expensive and time-intensive to treat.
- Of the respondents, nearly half (48%) are 40-64 years old, 36% are 27-39 and 16% are 65 or older. Patients who discuss their social determinant of health challenges with a clinician are more likely to accept help. Younger patients, while twice as likely to discuss, are less receptive to assistance.
Clinicians have been trying, and mostly failing, to find efficient methods to address SDoH. According to Waystar, those methods aren't necessarily all bad — they're just "misapplied," as in, used on the wrong patients. Most conversations about SDoH, the authors note, are happening with patients who are least likely to have health issues and least likely to take advantage of the medical supports clinicians offer.
From both the provider and payer sides, the answer to SDoH so far has largely been value-based payments for population health management programs, shown to work best when carried out in tandem with community partners such as social workers and local government agencies.
A recent study of safety net provider Eskenazi Health in Indianapolis demonstrated both the efficacy and lack of utilization of wrap-around services such as consultations with dietitians, social workers and behavioral health professionals. Researchers in that study found that only 7% of patients volunteered for more than one of those services.
Those findings were corroborated in another recent study, this time from the Annals of Family Medicine, where researchers analyzed a yearlong pilot in which three separate clinics tested a suite of EHR tools used to screen for and document SDoH. They found that the majority of patients are not interested in receiving help from clinicians. Only 15% to 21% patients indicated wanting a clinician's help addressing their socioeconomically-induced health condition.
That might be why most physicians don't believe addressing SDoH is their responsibility despite agreeing on the impact SDoH have on patients' health. Many believe the challenge of addressing those factors belongs to government.
Federal officials have shown interest in taking action to alleviate some of the socioeconomic impacts on population health, but that action involves shifting much of the responsibility back onto payers and providers. Addressing socioeconomic impacts on a person's health — which is influenced by ZIP code more than anything — can "feel like a frustrating, almost fruitless situation for an American healthcare provider," HHS Secretary Alex Azar said at a recent symposium.
Azar didn't say much about his plan during the symposium, but hinted that it would involve a "decentralized, flexible" government that can offer incentives to private sector providers.
Some private sector providers are already stepping up. Earlier this year, Intermountain Healthcare announced a $12 million investment in an initiative that aims to tackle housing instability, utility needs, food insecurity, interpersonal violence and transportation alongside city, county and state government agencies and community-based organizations in Utah.
Payers aren't ignoring the issue, either. More than eight in 10 insurers are currently integrating SDoH factors into their member programs, according to a recent Industry Pulse survey.
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