- Despite the hype surrounding the importance of social determinants of health, just a quarter of hospitals and 16% of physician practices screen patients for social needs that affect health outcomes, according to a JAMA study published Wednesday.
- Providers that serve more economically disadvantaged patients, practices with exposure to payment reform models and academic medical centers were most likely to screen for all five factors CMS has prioritized: food insecurity, housing instability, utility needs, transportation needs and interpersonal violence.
- Patients were most likely to be asked about interpersonal violence and least likely to be asked about utility needs, according to the report.
Social determinants of health are top of mind throughout the healthcare industry. Hospitals and practices are teaming with local communities to improve circumstances for patients, as these factors are closely and deeply tied with individual health outcomes.
Payers, meanwhile, recognize that patients not struggling with access to transportation and housing are more likely to follow through with treatments and seek preventive care that can save money down the line.
And there's reason to believe patients are open to more intervention. A survey earlier this year found that about 93% of those questioned said they wanted their doctors to ask them about access to meals and 83% wanted to be asked about safe and stable housing.
The JAMA study authors noted that while screening for social needs hasn't historically been considered a part of the medical process, increased attention to value-based care and holistic, team-based treatments have pushed providers in that direction.
"The role of physicians and hospitals in meeting patients' social needs is likely to increase as more take on accountability for cost under payment reform. Physicians and hospitals may need additional resources to screen for or address patients' social needs," they wrote.
But some high-profile organizations are making the effort. For example, Kaiser Permanente launched a social health network aimed at reducing homeless, food insecurity and other concerns in May. The program, called Thrive Local, will connect to the health system's EHR and be made available to nearby community-based organizations.
And UnitedHealthcare and the American Medical Association are working together to create more than 20 new ICD-10 codes that address social determinants and would trigger referrals to social and government services.
In the JAMA report, hospitals cited lack of financial ability, time and incentives as major barriers to screening for social determinants.
An invited commentary published with the research noted overcoming those hurdles will be key to making population health programs more accessible.
"Ultimately, the adoption of social risk screening is likely to be advanced both by well-designed financial incentives and by addressing potential adoption barriers," wrote Rachel Gold, an investigator at the Kaiser Permanente Northwest Center for Health Research, and Laura Gottlieb, associate professor of family and community medicine at the University of California, San Francisco.
"A diverse array of such barriers may be encountered; for example, evidence-based interventions may not be available, clinic leadership and staff may lack an understanding that social risk data can help improve care outcomes, and there may be inadequate staff training in how to conduct such screening," they wrote.
The researchers noted, however, that it's unclear whether better screening of social factors would lead to improved care or lower spending because of scant research in the area.
The study reviewed information from nearly 2,200 physician practices and more than 700 hospitals.