Dr Robert Groves Explains Social Determinants of Health Challenges

Robert Groves, MD, of Banner | Aetna explained the challenges primary care practitioners (PCPs) face when addressing social determinants of health (SDOH). This topic was thoroughly discussed at the The American Journal of Managed Care^®’s Institute for Value-Based Medicine^® (IVBM) in Phoenix, Arizona, on December 12, 2023. Groves was a co-chair of the event.

Groves currently serves as the first executive vice president and chief medical officer of a new health insurance plan in Arizona formed as a joint venture between Banner Health and Aetna. As part of his role, he provides corporate strategy and physician leadership in population health management to ensure the delivery of high-quality clinical performance and evidence-based utilization.

Transcript

The IVBM was centered around the challenges PCPs face in addressing SDOH issues. Could you please explain what some of these challenges are?

There are lots of challenges. First of all, asking PCPs to do one more thing. This is a specialty that's under siege. We have not supported primary care effectively for decades, and we're losing PCPs right and right. You may argue that some of that will be replaced by transactional services in retail with some of the larger providers, like Amazon, CVS, et cetera. But there are really 2 kinds of patients; this is an artificial distinction, and yes, you can divide them up more.

There are the kinds of patients who want transactional services; those are usually not life-threatening issues. You got a sore throat, or you jammed your finger, whatever it is that brings you into an urgent care or one of those facilities. Primary care is about relationships long term, and in order to serve the second set of patients, and those are the ones with serious chronic illness, or who have had a serious health event in their lives, they're usually looking for somebody they can trust and develop a relationship with over time, somebody who can be the quarterback for their care team. Those kinds of physicians, not through their own fault, are fewer and further between.

When we ask doctors to see patients in 10 minutes, to see new patients in 30 minutes, it's asking too much. You can't really understand patients, you can't understand their motivations, and you can't even get a full picture of their disease if you have that limited amount of time with them on an infrequent basis, and I consider monthly infrequent with regards to the rest of our lives.

I think that we brought that problem to the floor a little bit, as well, not specifically, not directly, but it's part of the overall mix. We need to free up time for PCPs to getting back to what PCPs do best, which is establishing relationships with their patients, developing trust so that they can develop influence in the behaviors of those folks.

We also reviewed data that's very clear that only about 15% to 20% of health outcomes, particularly in terms of longevity health span, are accounted for by the $4.5 trillion that we spend every year. Most of it has to do with genetics, but a huge chunk of it has to do with behaviors, and then a chunk of it has to do with zip code with context. In other words, is there pollution in the community? Is it a food desert? Is there violence? All of those sorts of issues come into play.

What we spend $4.5 trillion on is really rescue medicine. It's after a chronic disease has developed, after an accident has happened, it's trying to salvage those folks whose context has led them to the point in time where they have a serious chronic illness. Now, some of that is good, we're living a lot longer and on balance; the modern health care rescue system adds 7 years of life, and, by the way, at my age, I value 7 years of life, I want that.

When we try to charge that system with the health of a population, we have missed the whole point because we are rescue medicine. If you want a healthy population, the literature has been clear for some time. What you do is you invest in education and opportunity; you have a solid safety net in place for those who fall through the cracks, you guarantee the availability of not just rescue medicine but prevention to all citizens.

If your goal is to improve healthspan and lifespan, when we compare ourselves to other countries, we find we're ranked 32. It's not because of our rescue medicine system because it's simply not designed to do that. We excel, we lead the world in rescue medicine, there's absolutely no doubt about that, hands down, no discussion. If you get hit by a car, if you develop cancer, if you have a heart attack, there is no better place to be for health care. We, still, in the world, get the best outcomes, and we lead the world in innovation.

So, the question we have to ask ourselves is, what is the job to be done? Do we want to continue to devote all of our resources to rescue medicine? Or, is it time to support social services, social policies, and public health so that we can actually have an increase in healthspan and lifespan? That's, as a society, a question we have to answer.