Physicians have long struggled to get patients and families the appropropriate services to address food insecurity, housing and other needs outside the realm of traditional healthcare.
But with an increased focus on the social determinants of health, physicians are seeing the problem as more widespread than was first believed.
Steps to solving it include technology that fits clinicians' needs and improved payment models, said experts who spoke Thursday during the Connected Health session, "Leveraging Social Determinants of Health for Better Care: Community/Provider Cooperation."
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Dr. Eric Fleegler, an emergency room physician at Boston Children's Hospital, began working to tie the social determinants of health to outcomes about 20 years ago. Early on, he said, there was a zero understanding of how to approach the problem from a medical standpoint.
"One of the remarkable things are just how prevalent these problems are," said Fleegler, who is also medical director for Veta Health. "They can range from 50-80% of families."
Eighty-five percent of solving illnesses has to do with the social determinants of health, and the majority of issues exist outside the walls of healthcare, said Somava Stout, vice president of the Connected Health Institute for Healthcare Improvement. About 10-20% is within the walls of a hospital, and 60% is outside those walls. A child growing up in poverty has greater chance of being ill in adulthood, she said.
"We're solving poverty after the fact," Stout said.
Among the biggest challenges is that the payment system isn't aligned with paying for social determinants across cross sector collaborations, Stout said.
Another challenge is technology. Data is currently attached to the EHR, but providers need a system that's built from the ground up, said Josh Lemieux, vice president, Development and Strategic Partnerships, at the nonprofit OCHIN.
Physicians and nurses need to know, did an SDOH solution work? he said. This requires making the technology and training a priority of leadership, he said.
There is so much to be learned about the design of technology for it to be useful, Stout said.
It takes a collaborative effort, someone within the clinician team who can handle SDOH requests from physicians. This helps to reduce physician burnout when other resources are available.
The social determinants of health from the lens of healthcare delivery systems requires three pillars of work, said Tom Sequist, chief quality and safety officer for Partners HealthCare. These include healthcare equity within the hospital, from any implicit bias to the EHR and patient portals to staff training and cultural competency. The second tier is diversity in the workforce, and the third is community partnerships, Sequist said.
"It's a huge return on investment," Stout said prior to the session. "It takes us back to the core of training, to see the whole person. We have medicalized that out. Every medical student gets trained to see the whole person, then we beat it out of them."
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