We must address social determinants of health now

Social determinants of health (SDOH) are not a new concept among health care leaders; but they are receiving increased attention from physicians, media and policymakers of late. This is in part because the upcoming 2020 elections are once again pushing health care reform to the front of the national agenda. There is an increased realization among physicians that social determinants are influencing health care behaviors and negatively influencing patient outcomes.

What’s more, Congress’ first proposed bill to address SDOH in payment models is spreading awareness that SDOH -- the conditions into which people are born, grow, live, work and age -- have a profound influence on both health outcomes and costs. Physicians are keenly aware of the impact of SDOH on their patients. In The Physicians Foundation’s 2018 Survey of America’s Physicians, 88 percent of physicians reported that many or all of their patients have significant social needs that pose a threat to their health.

It is important to understand just how SDOH affect patients and physicians. For patients, SDOH often manifest themselves in a lack of access to safe housing, nutritious food and transportation. With these deficits and at the most basic levels, patients frequently are not able to adhere to their physicians’ care instructions, or even get to medical appointments, despite their desire to be adherent. For many other patients-like those diagnosed with influenza in winter-poor housing, a lack of heat, and substandard nutrition can all combine for a deadly outcome.

Unaddressed SDOH severely limit physicians’ abilities to improve patients’ health, but they also have cascading effects beyond patient care. A key component of physician burnout is the inability to address the root causes of their patients’ poor health adherence, made all the more difficult when there are obstacles like SDOH that physicians find themselves helpless to address.

Physicians may have access to cutting-edge medical research, technology and treatments, but find themselves unable to help patients get to offices, access nutritious food and afford ever rising prescription costs. Prescription costs are increasing dramatically, as now $1 out of every $4 spent in health care is industry is spent on pharmaceuticals. Comparatively, $1 in every $3 is spent on hospital care.

Integrating systems to help physicians ameliorate SDOH is one of the most substantial challenges we have in health care. Addressing SDOH is the only way we will develop a health care system that achieves better outcomes with reduced costs. Expanding coverage to every American will not limit utilization and promote health and wellness unless we can link these changes to the social drivers that promote health compliance.

A long-time advocate for addressing SDOH, the Physicians Foundation believes the integration of SDOH into payment and care delivery systems will allow physicians to address SDOH more efficiently and effectively, resulting in healthier patients. This can be achieved by adding SDOH measures and financial incentives into new payment models, whether the reimbursement comes from private payors, state or national programs.

While policy reform will significantly aid in physicians’ attempts to address SDOH, there are measures that can be taken on a system level to address SDOH. Fortunately, medical practices have recognized the need to screen patients for potential social needs. However, helping physicians understand how they can best support their patients should be prioritized. Physicians already feel stressed for time, so another way to alleviate the burden is to have medical students help with the process. Not only are they addressing SDOH, they are learning how these social drivers affect the industry and are proactively changing the health care system they will enter one day.
In addition, insurers could create billing codes that pay physicians or other staff for identifying SDOH and connecting patients to helpful community services. Doing so can lessen the burden of the uncompensated time physicians spend looking for resources. While these are simple measures, they will help physicians, and especially patients, as they work to address SDOH. 

State medical societies that advocate for physicians, patients and their state health care needs could integrate SDOH into the support they provide their physician members. For example, many state medical societies must help support their physicians by making SDOH a central pillar in their own state legislative reform efforts. By advocating for inclusion of SDOH in their state’s Medicaid and CHIP reform, the burden on physicians and patients will lessen as they take steps to address SDOH.

Finally, there are steps individual physicians may take to alleviate SDOH burdens. In my practice, I observe daily how SDOH affects my patients’ health outcomes, an experience that needs to be shared with policy makers. It is critical that physicians’ voices are heard while developing new health care policies, including implementing measures to address SDOH.

We understand most intimately what our patients need, and we must advocate for measures that address their interests. Physicians must be empowered to engage in the policy discussions surrounding health care reform. Policymakers can and should rely on our first-hand patient experiences affected by SDOH. It is the only way to ensure our country is developing policies that advance patient care, engage physicians and yield better and more cost-effective health outcomes.

Joseph Valenti, MD, FACOG, is a member of the Board of Directors of the Physicians Foundation and a practicing OB/GYN.