How hospitals are measuring, addressing social determinants of health

More hospitals are screening patients on health-related social needs as the industry has recognized the importance of factors outside the healthcare system on outcomes. The investments and available funding, however, haven’t been consistent.

In a survey conducted by Deloitte and presented at the 2018 AcademyHealth National Health Policy Conference In Washington, D.C., responses were collected online from nearly 300 hospitals and health systems. Support for and recognition of the importance of social determinants of health was high—88 percent said they were screening for social needs, most often for inpatient (90 percent) and high-utilizer populations (83 percent). Large, nonprofit, disproportionate share hospitals (DSH), as well as publicly-owned facilities, were the most likely to screen for social needs.

Value-based care participation also appeared to be a factor. The more models a hospital was involved with, the more likely they were to measure more social needs activities including number of people connected to community resources.

However, Deloitte also found many of the activities were fragmented and only reaching some targeted populations. About 50 percent of responding hospitals reported directing their resources or interventions to specific segments of the patients they serve.

“We’ll be doing a housing and caregiver needs assessment, asking if the patient has two stories in their house and will have trouble with stairs; only to find out the patient doesn’t have stable housing,” one respondent said.

One of the most common challenges hospitals reported was sustainable funding for these efforts—72 percent said they don’t have dedicated funds for all of the populations they wish to target.

This could change, respondents said, if organizations could see the return on investment from addressing social needs. When asked what data would spur additional investment in these initiatives, 51 percent of hospitals said evidence of cost reductions and 48 percent selected evidence of improved outcomes.

“Organizations need the ability to collect meaningful data, select appropriate metrics, track them, and understand which components of a given intervention are able to produce an impact,” the report said. “Many of our interviewees note that looking at finances over a fiscal year or other short period of time may not be optimal for realizing improved health outcomes from social needs’ initiatives.”

Making the data easily accessible would help, too. Less than a third of respondents said they were integrating social determinants into their electronic health records (EHRs), a problem which could be tackled by the first of the report’s four recommendations to better address health-related social needs:

1. Break down silos and consolidate resources. Rather than duplicating efforts and adding more burden to staff, health systems and hospitals should streamline their screening tools across all departments and make sure teams stay in regular communication.

2. Continue the move toward value-based models. As evidenced by the earlier finding, value-based models encouraged measuring more social needs.

3. Identify strategies to improve the ability to track health and cost outcomes. Rather than relying solely on hospital-collected data from claims and patient intake forms, data from outside systems, like payers, community groups and the government, would help paint a more comprehensive picture of social determinants.

4. Share best practices. Since respondents said knowing the ROI would spur more investment in social needs efforts, health systems need to share what’s worked and what hasn’t in venues like research forums or conferences.