Integrating Social Determinants of Health

One in three men and one in two women will have a cancer diagnosis in their lifetime. But it doesn’t have to be that way.

Mishellene McKinney, MHA, RN, OCN, Vice President, Cancer Care Services, Kaiser Permanente; and Anand Shah, MD, MS, Vice President, Social Health, Kaiser Permanente, discussed this during their presentation, “Integrating Social Determinants of Health,” at the 2022 Oncology Clinical Pathways Congress.

“Over 42% of cancer is preventable through modifiable risk factors like diet, exercise, and smoking,” McKinney said. “But it really isn’t enough to try to target those risk factors at the individual level. You really need to think about the social determinants of health, which are the factors that impact the environments in which we are born, live, work, play, and worship.”

Kaiser Permanente’s Thrive Local Social Health Network aids in addressing pervasive and emerging inequities among Kaiser Permanente members. According to McKinney and Shah, social factors such as lower household income, language barriers, lower levels of neighborhood income and education, and food insecurity impact cancer outcomes.

Members of color are twice as likely to report having a severe social need. Approximately 42% of members struggled with paying bills, 35% of members experienced social isolation, and about 8 million members have at least one social factor they need help with.

“When I joined Kaiser Permanente, one of the first questions I asked my team was what do we know about the prevalence,” Dr Shah said. “We commissioned a couple of surveys, one representative of Americans and one of our members. And what we found, which was surprising to us, was that 63% of our members, who are by definition insured, experienced a social risk in the past year. This was across all our markets and lines of business. We found that about 30% of individuals in our survey of Americans reported that they were routinely making decisions between following up with medical recommendations and addressing their needs to food, access, and transportation.”

Building Kaiser Permanente’s Social Health Practice requires a societal shift, integrating social health practice into Kaiser Permanente’s care model for members, effecting local impact by supporting those communities with social health integration, and merging social health into other health care systems and communities.

“Systems have a huge impact on health and well-being, and we’ve made major investments,” Dr Shah continued. “When we think about the social context to support our members and connect them to services in the community, that’s a big part of what we’ve been working on at Kaiser Permanente. That is very much the aggressive journey we’re on.”

One of the most common social health inequities in cancer patients is food insecurity, which is experienced by roughly 55% to 70% of low-income and medically underserved cancer patients. Additionally, Black cancer survivors are twice as likely to be affected than White survivors, and young adults more so than older adults.

Along with food insecurity, other top social health inequities are housing insecurity, social isolation, financial wellbeing, and digital equity.

The Thrive Local program is hoping to address these needs by connecting members to community-based resources and help them with engagement opportunities through online directories, call centers, and care delivery teams.

“We’re investing in our Thrive Local Network, which uses a technology platform that helps us catalog resources across our communities,” Dr Shah said. “So we have about 60,000 organizations where our members, the community at large, anyone can access these resources. It’s available for free on our website; it’s also available for referral through our EHR and also through a national call center that provides services.”

The framework of the practice will include key programs and initiatives based on the need to identify, connect, and support and follow-up.

“Once is not enough in terms of screening,” McKinney said of the need to follow up and monitor patients. “The social risks of cancer span the entire continuum, and so should our assessments.”

In closing, McKinney said that there is a need to think about defining the what, who, and how during consideration of treatments and programs.

“The hardest part about all of this is how do you operationalize this?” she asked. What tool best aligns with your organization’s capacity to be able to capture and address social needs?

“My final message is that we can’t do this alone and we can’t be everything for our patients. Doing social assessments on a regular cadence and creating partnerships and referral programs within the communities we serve are really the key to getting our patients the full spectrum of care that they need.”