Focusing on Social Determinants of Health: How to Make an Impact
Consideration of patients’ social determinants of health (SDoH) has been a facet of healthcare delivery in the United States for decades. The CDC defines SDoH as the nonmedical factors that influence a patient’s health outcomes, such as access to care services and medication, housing and food stability, education levels, and employment.
During the COVID-19 pandemic, SDoH became a more prominent area of focus for providers and insurers, as inequities in access to healthcare became more apparent. Most healthcare professionals have an intuitive understanding of why SDoH matter, and in fact a 2023 MMIT survey of oncologists, practice managers, and payers found a high level of awareness around SDoH.
But agreeing on the importance of SDoH and operationalizing initiatives to address them are two completely different things. Let’s take a look at how payers, providers and other healthcare stakeholders can approach SDoH strategies.
Not just a buzzword
Once a patient is experiencing symptoms or diagnosed with a disease, the environmental and social factors of their lives almost invariably influence their clinical care and, in some cases, outcomes. But what factors are perceived to influence good—or poor—health?
In 2023, MMIT asked this question to a cluster of oncologists and payers who had acknowledged that their patients experienced difficulties related to SDoH. When asked what SDOH factors specifically kept their patients from maintaining good health, the top answer was a patient’s socioeconomic status, i.e., their ability to pay out of pocket (92% of payers; 67% of oncologists). The second SDoH factor of primary concern was a patient’s education and health literacy (87% of payers; 45% of oncologists).
As new policies are implemented to support underserved patient populations, SDoH remain a prominent concern of regulatory bodies. For example, in April 2024, the Centers for Medicare & Medicaid Services’ proposed new SDOH provisions to the rule that guides reimbursement for long-term care hospitals in 2025. If approved, long-term care hospitals would need to collect SDoH data related to housing, transportation, and food and utility stability.
This proposed provision is not the first time SDoH has appeared in CMS payment rules, and points to the continued integration of SDoH data into health policies and processes among payers, providers, and patient advocates.
Navigating the sea of SDoH
A primary challenge of working with SDoH is sifting through the sea of data and topics to identify a specific area that is ready for action. This can be daunting, as the definition of SDOH is inherently flexible and at times, general. Non-medical factors that influence health outcomes can include everything from a person’s available transportation to their social network, literacy, internet access, and even their parents’ educational attainment. As the list grows, it becomes apparent that one stakeholder cannot influence every aspect of SDoH.
In short, strategic SDoH operations require leaders to look beyond generalities and focus on the areas in which they are most likely to effect change. Identifying a key therapeutic area can be a helpful first step. In a 2023 MMIT survey, commercial and Medicare payers selected these therapeutic areas as the ones in which SDoH impacts the most patients:
- Oncology
- Endocrine & metabolic disease (e.g., diabetes)
- Infectious diseases (e.g., HIV/AIDS)
- Rare diseases (e.g., Gaucher disease)
This list shared some similarities with the answers oncologists provided MMIT in 2023 in response to the same question:
- Hematology
- Oncology
- Autoimmune diseases
- Infectious disease (e.g., HIV/AIDS)
A common theme between the payers’ and oncologists’ lists of impactful therapeutic areas is the chronic nature of the diseases listed. A patient with a chronic illness typically needs more long-term support. Similarly, a patient with cancer may need a care plan that incorporates transportation to their infusion appointments to ensure their treatment stays on track.
Payer, provider and manufacturer interventions
Payers have a vested interest in managing or monitoring patients’ SDoH to calculate risk and reduce healthcare costs. Over the years, some of the largest commercial payers in the U.S. have reported on their health equity and SDoH initiatives to their shareholders in quarterly earnings meetings.
The COVID-19 pandemic influenced this practice in some ways, leading to a rush of new SDoH-related programs. Some payers began financially incentivizing community-based organizations to address social needs, while others funded nonprofits to close care gaps or build affordable housing. But even as the pandemic fades, many commercial payers are still developing new SDoH initiatives.
Provider organizations are also partnering with community-based organizations to address SDoH, and many larger providers dedicate full-time employees to care management support and resource coordination. However, building sustainable programs that influence SDoH is a challenge for many health systems, as they need long-term funding beyond just a pilot program. Provider/state partnerships may be a way forward, as recent expansion of Medicaid’s managed care authority should allow states more flexibility to address health-related social needs for Medicaid recipients.
As for manufacturers, most include detailed SDoH data collection in their clinical trial enrollment process, and many are striving to increase diversity in their studied patient populations. As of this year, pharma companies with drugs selected for the Medicare Drug Price Negotiation Program will need to provide comparative effectiveness research that shows the value of their treatment for specific patient sub-populations, including those that were underrepresented in initial clinical trials.
According to the U.S. Department of Health and Human Services, many of the health conditions treated by drugs selected for the first cycle of Medicare drug price negotiations “are associated with disparities in prevalence, health care access, and outcomes based on race and ethnicity…[these disparities are] driven by a variety of factors, including health-related risk factors; genetic factors; socio-economic factors; and structural inequities.”
Insights on how to set SDoH priorities
Where does that leave stakeholders from an operational perspective? Identifying the prevalence of a certain SDoH in a patient service population can determine how an organization can effectively allocate resources to improve results.
In 2024, the American Journal of Managed Care published a study from Humana researchers in which new Medicare Advantage enrollees were asked about their health literacy after they enrolled in a new Humana MA plan. Nearly 18% of participants had low health literacy, and Humana reported that these results will help them stage and implement patient interventions.
Innovation in the SDoH space will require leaders to answer these key questions:
- Which therapeutic area can my organization make the most impact in?
- Which specific SDoH factor can my organization drive the most change in?
- How can my organization effectively and compassionately collect accurate SDoH data?
- How can data influence the design and implementation of a strategic initiative?
- Does my organization have the right community partners to bring a strategic SDoH initiative to life?
Integrating SDoH into clinical care workflows requires careful planning and knowledgeable partnerships. With the right strategy, healthcare stakeholders can use SDoH data to make a positive community change.
To track current and emerging trends, learn more about MMIT’s Biologics & Injectables Index and Oncology Index. To connect patients in need with financial assistance programs, learn more about our Patient Reimbursement Database for specialty pharmacies.
