Holistic Approach Required to Effectively Reform Social Determinants of Health

Understanding patients so that health professionals can meet them where they are is crucial in implementing actionable steps to improve social determinants of health (SDOH), emphasized health experts during a webinar hosted by NEJM Catalyst called “Social Needs and SDOH: Impact on Patients and Communities.”

During the webinar, 2 speakers and moderator Thomas H. Lee, MD, MSc, talked about how addressing SDOH effectively depending on each situation can help patients quickly and save payers money. Lee is editor-in-chief, NEJM Catalyst Innovations in Care Delivery; co-chair, NEJM Catalyst Editorial Board; and editorial board member of the New England Journal of Medicine.

Joining him were John R. Lumpkin, MD, MPH, executive strategic counselor for corporate social responsibility at Blue Cross Blue Shield of North Carolina (BCBSNC); and Stacy Tessler Lindau, MD, MAPP, Catherine Lindsay Dobson professor of Obstetrics and Gynecology and professor of Medicine at the University of Chicago.

Lumpkin started the discussion by posing the question of the role of health care in solutions to address SDOH, and why a health insurance company should be concerned about food insecurity, for example. He gave an example of a collaboration between BCBSNC and the Hunger and Health Coalition to address food insecure members in a demographic area by initiating a lucrative capitated payments arrangement.

“To be successful, we must develop the evidence that supports the business case addressing drivers of health needs, and health care and health insurance companies will need to go outside the comfort zone and adopt more flexible modes of operation,” said Lumpkin.

Lindau was asked her opinion on how best to implement a community engagement program. She stated that an idiosyncratic program doesn’t work, and that engaging with the communities that need assistance to learn what kind of information they want, such as hours of operation and availability for resources, is the most important aspect.

The panel was asked about the moral and business cases for addressing SDOH in the health care space, and one answer came from Lumpkin, who said, “…the business case is really something I didn't appreciate till I came to work in insurance. I started out my career in emergency medicine, and I went to public health. And we always believe that prevention works. When you get inside a company, they say, prove it. And that's really where the challenge is.”

BCBSNC has supported research that allows learning to occur and evidence to be shared that can transform health insurance to improve the health and well-being of all people, Lumpkin added.

Lee asked Lumpkin and Lindau to react to the idea that health care organizations should be competing on the value of their health care, not trying to solve social challenges that are outside of their scope.

In his view, addressing non-clinical factors like Supplemental Nutrition Assistance Program enrollment is necessary for good health outcomes, Lumpkin responded. Caring for people shouldn’t be limited to when they’re sick or injured, he explained, but should also include helping them live their best lives.

Lindau’s reaction was that if a health care provider’s job is to foster overall health and not just address acute concerns related to specific organs or diseases, it is their responsibility to make sure that preventative care and medical interventions can be carried out by the individual after they leave the clinic.

Lumpkin noted that, “if you screen for social needs, you have to have an answer,” using the example of the insurance company reaching out to individuals predicted to be at risk of food insecurity or falls to offer them assistance on an individual level. He also explained that screening for the risk of social needs like food insecurity based on individual factors such as income alone may not always be accurate.

Figuring out how to take universal approaches to improving patient wellness that do not necessarily require individual screening—like providing resources to practitioners—could also help address patient needs on a large scale, Lindau noted.

“I think we've got the secret sauce that we need to actually make some progress. I don't think any one of [the elements discussed] alone is enough. But we need to know those right norms. We need the digital infrastructure, and we need the payer infrastructure to be working together in pursuit of these values,” said Lee.

Reference

Beach MC, Berkowitz SA, Davis N, et al. Social needs and SDOH: impact on patients & communities. NEJM Catalyst webinar. March 9, 2023. Accessed March 20, 2023. https://events.catalyst.nejm.org/events/social-needs-and-sdoh-impact-on-patients-communities