Advancing Health Equity by Addressing SDoH, Health Disparities

As much as 80% of health outcomes are driven by social determinants of health (SDoH) which are defined as the community-level conditions and environments in which people live, work, learn, worship, and age. 

Kim Ibarra, MBA, MSc, managing director, National Quality Forum, presented at AMCP Nexus 2020 on the importance of understanding how SDoH play a significant role in overall health outcomes, and if properly addressed, could play a significant role in reducing health disapities and improve health equity. 

She explained, according to Health Payer Intelligence, SDoH impact health more than biology and health care. These socioeconomic factors contribute to disparate health outcomes and include age, geography, language, gender, disability status, citizenship status, access to food and transportation, education, economic stability, sexual orientation, and more. 

Currently, “less than one quarter of health systems are using SDoH in their clinical decision making,” said Ms Ibarra. There are a number of federal initiatives to address SDoH, including the Accountable Health Communities Model, which tests screening, referral, and navigation to connect patients with services to address health-related social needs; recent changes to Medicare Advantage that grant flexibility to address health-related social needs; and proposed bipartisan legislation  that would enable states to improve health outcomes through cross-sector SDoH approaches. 

Ms Ibarra explained how state-level programs are making strides with their own SDoH initiatives included in managed care contracts or Section 1115 waivers. In fact at least 40 states have these initiatives built in. The State Innovation Models Initiative provides funding and technical assistance to states to develop and test payment and delivery reforms and some state Medicaid programs focus on Delivery System Reform Payment (DSRIP) initiatives. 

For example, Ms Ibarra said, Texas providers use DSRIP funds for fridges in homeless shelters to improve access to insulin and Medicaid Managed Care Organizations in Nebraska have required SDoH staff training.

Another example Ms Ibarra provided was the different way funds could be used under health plans to better support patients with asthma—a plan could pay for an air filter to improve home air quality to reduce symptoms, therefore creating a better quality of life and reduce symptoms and in turn, reduce costs. 

“Demonstrating value can be challenging,” said Ms Ibarra. “Demonstrating [return on investment] can be challenging, but early research, tools, and case studies show promise.” Because many of these initiatives are still new, data is limited but what exists proves that by incorporating SDoH into care decisions produces better outcomes. Potential costs of unaddressed SDoH include:

• Risk of chronic conditions;
• Increased health care costs;
• Avoidable health care utilization; and
• Mortality risk.

“Organizations need to start testing SDoH programs to create a pool of real-world data that we can build upon to improve resources and programs,” explained Ms Ibarra. She went on to explain the importance of collaboration in this process. 

In a portion of the presentation where Ms Ibarra focused on enhancing health care to reduce disparities and improve outcomes, she offered advice and actions that health care professionals can apply in their own health practice which are shown to be effective based on study data, expert insights, and existing programs:

• integrate SDoH data into clinical care;
• break down silos to enable successful partnerships;
• expand core services to include nonclinical solutions;
• advance SDoH measurement; and
• change conversations and organizational culture.

“Partnerships are critical,” explained Ms Ibarra. “To effectively address SDoH, partnerships between diverse stakeholders are essential,” including health systems, payers, community-based organizations, government entities, employers, policymakers, clinicians, consumers, and pharmacists. People are more likely to implement these services or initiatives if they have a really good understanding of what SDoH are, how they clinically impact outcomes.” 

Another key component of successfully addressing health equity through SDoH is by changing conversations and organizational culture. SDoH data has shown a number of disparities including infant mortality rates among non-Hispanic Black women across all ages. Another timely example is the higher COVID-19 pandemic infection rates and mortality risks among Black and African Americans. 

Study data from the American College of Cardiology showed that “empathy can counteract implicit bias, improve adherence, and satisfaction” and that asking if there are ways to help can be effective tool.

“Data integration, partnerships, service expansion, measurement, and changing the conversation can help advance health equity,” concluded Ms Ibarra. —Edan Stanley