Hospitals and health systems address impact of social determinants and other non-medical factors

In a representative survey of 300 hospitals and health systems, the Deloitte Center for Health Solutions discovered that:

“80 percent of hospital respondents reported that leadership is committed to establishing and developing processes to systematically address social needs as part of clinical care. However, our findings also indicate that much activity is still ad hoc (defined in our survey as occasional and only reaching some of the target population), and gaps remain in connecting initiatives that improve health outcomes or reduce costs.”^[1]

In addition to the recognition that non-medical factors (including social determinants) have a significant impact on clinical outcomes---exceeding the impact of health care delivery^[2] ---hospitals and health systems working under value-based reimbursement are discovering that interventions in this area can improve performance in value-based reimbursement.^[3]

As noted in the Deloitte report, these efforts are ad hoc, address only some of the target population and opportunity gaps remain.  This is an opportunity to apply science and technology to reduce those gaps and help more people achieve better outcomes.

Science: There are tools that systematically unmask these non-medical factors through well researched health risk assessments.  Responses predict risk factors that can lead to a 2-3 times increase in hospitalization and emergency department visits.^[4]  Brief interventions based on responses lead to better outcomes.^[5]

Technology:  Advancements in Natural Language Processing unlocks the vast trove of information in unstructured data.^[6]  When we add this to structured data we have the potential of systematically unmasking non-medical factors (social determinants being one type) that heavily impact outcomes.  These factors can then bring vastly nuanced information to the way we identify risk factors and can be applied at scale.

Adding it all up, we are at an inflection point in health care where we can adopt technologies that have been used extensively in other industries and apply evidence from published studies.  We can reduce the effort involved in sifting through medical records and sorting data and instead focus more energies on addressing people’s needs.

L. Gordon Moore, MD, is senior medical director for Populations and Payment Solutions at 3M Health Information Systems.

[1] Thomas, Sarah. “Addressing social determinants of health in hospitals” Deloitte. social-determinants-of-health-hospitals-survey.html

[2] Schroeder, Steven A. “We Can Do Better — Improving the Health of the American People.” New England Journal of Medicine 357, no. 12 (September 20, 2007): 1221–28..

[3] Mosbaugh, Kathy. “Looking beyond medical data to deliver better care using social determinants of health.” (November 16, 2017) MedCity News.

[4] Wasson, John H., Laura Soloway, L. Gordon Moore, Paul Labrec, and Lynn Ho. “Development of a Care Guidance Index Based on What Matters to Patients.” Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, April 11, 2017..

[5] Von Korff, Michael, Gruman, Jessie, Schaefer, Judith, Curry, Susan, and Wagner, Edward. “Collaborative Management of Chronic Illness.” Annals of Internal Medicine 127, no. 12 (December 15, 1997): 1097..

[6] Oreskovic, Nicolas Michel, Jennifer Maniates, Jeffrey Weilburg, and Garry Choy. “Optimizing the Use of Electronic Health Records to Identify High-Risk Psychosocial Determinants of Health.” JMIR Medical Informatics 5, no. 3 (2017): e25..