Few healthcare organizations are investing in social determinants of health technology, and while an uptick is expected, the market will remain relatively weak until providers find the best way to use the data, according to a new analysis from Patchwise Labs.
The report found that fewer than 4% of health systems and managed care organizations have invested in SDoH technology. The consultancy puts the market currently at $88 million to $92 million.
Adoption should increase to between 12% and 15% by 2023, driven by the need for standardization around data capture and communication among community partners and healthcare providers.
While the analysis highlights an opportunity for technology entrepreneurs, the field is nascent compared to technologies like blockchain and machine learning that have clear, albeit hyped, use cases for the healthcare industry.
"Until there's a clear business case and market, we won't see widespread adoption of these tools," Naveen Rao, founder and managing partner for Patchwise Labs, told Healthcare Dive.
Social determinants of health is a phrase du jour as the industry slowly shifts payment models from volume to value. However, as the report points out, the SDoH market will largely be dependent on how community-based organizations such as food banks and housing organizations are engaged and integrated into the larger health ecosystem. Many thought leaders have called on the industry to consider the actual meaning of the phrase before turning it into a marketing pitch.
Town Hall Ventures co-founder and former CMS administrator Andy Slavitt, for example, said last month at HLTH18, "I encourage people to ... come up with ideas how to solve [social determinants of health]. To turn them into models before we understand them kind of scares me."
Evidence is mounting that addressing social and mental factors for people has downstream benefits for their health. For example, a study published in Health Affairs in April found a population health program that addressed access to care and SDoH reduced emergency department and inpatient care visits.
The goal is to drive down healthcare spending, which is expected to grow at an average rate of 5.5% per year from 2017 to 2026.
Moreover, more people are understanding what SDoH actually are. "[The] need for customer education is still there, but compared to three years ago, we no longer have to define and explain the concept of SDoH — it's already in our customer's heads," a tech executive told Patchwise Labs for the report.
The four central features emerging tech vendors are building, according to the report, include:
- Up-to-date resource directories of local social service providers.
- Needs assessment screening tools.
- Closed-loop referral platform to facilitate care coordination.
- Reporting and analytics tools to fine-tune performance.
The study found payers are currently leading the way in the evolving market. Interest in the space has shifted payer conversations from reimbursement framework reformation to rethinking non-clinical areas for engagement to help contain costs. This line of thinking has lead to several mergers in the space, including the CVS-Aetna proposal and Anthem-Aspire Health.
Hospitals and health systems, according to the report, could leverage their community needs assessment work as well as integrate social care planning into care coordination efforts more to address SDoH. Screening tools and/or referral programs exist within hospital walls but, according to Rao, the care delivery industry is still in the blocking and tackling phase regarding SDoH.
Health systems such as Geisinger — which expects to prescribe about 1.5 million meals by the end of this year and offers free rides for patients — are moving the needle on SDoH efforts but they have hardly hit the mainstream. There's also a question over what role health systems should actually provide for such efforts.
"In managed care, each department knows what they're doing, but providers are still figuring all of this out as they learn to manage risk and take on value-based contracts," an executive told Patchwise Labs. "This is all new work for them and the lines of authority are much less clear."
"I think increasingly health systems and physician groups are a part of their community ... and they're really well suited to try and engage ... families and individuals and work with all the local community agencies to do something better than what's being done today," Evolent Health CEO and co-founder Frank Williams told Healthcare Dive. "You have to start with what you have. With that work, you earn the right to start to influence broader policy," he said
And yet, as the value-based march continues, providers could be customers for SDoH if use cases become clear. "As value-based care continues to expand and payers begin addressing SDoH, the provider market could be the quickest to adopt new approaches to facilitating social needs referrals," the Patchwise Labs report said.
But a big question is whether technology companies can deliver. Currently, social data largely populate medical records as unstructured data, which can be a slog to get through for physicians and add to the administrative overload they feel on a day-to-day basis regarding documentation.
Moreover, SDoH data are varied, and there isn't an industry standard on where and how to compile data from social assistance programs into an EHR, the current torchbearer for health IT in the clinical space.
EHRs, which began as billing and coding systems for healthcare providers, were thrust into clinical settings when the HITECH Act incentivized their adoption. Physicians' reluctance and anger over adopting these systems has been well documented, but so far, the fact is the measure worked to help digitize the healthcare industry. EHR systems have been adapting to the current market opportunities with vendors opening up APIs and Epic CEO Judy Faulkner calling for a shift from an EHR to a CHR — a comprehensive health record.
However, Rao said while it's a great marketing tool, there's no business model for EHR vendors to shift all-in into SDoH. The main reason is that it wouldn't make sense, given the high costs of EHR contracts, for community field organizations to purchase such tools or EHR vendors to go after low-costs contracts.
However, as Rao said, social innovation is happening in the tech space regarding SDoH, and EHRs do play a part. Progress is currently coming from home-grown integration efforts that leverage EHR data for third party tools that deposit data into a central record.
How the embryonic market develops remains to be seen but, as use cases develop, acquisitions can be expected as the health IT market matures.