Transforming Healthcare Delivery by Addressing Social Determinants of Health: Implementation Lessons From the Field

Abstract

Purpose: There is mounting evidence that social determinants of health (SDOH) such as nutrition, housing, and transportation significantly shape health outcomes. Historically, health care organizations have played a limited role in addressing patients’ social needs. However in recent years, as new financial incentives emerge, an increasing number of health care systems are experimenting with interventions to identify and address SDOH. Despite growing enthusiasm, a 2019 study found that only 24% of hospitals and 16% of physician practices currently screen their patients for health-related social needs. One key barrier to broader adoption is the operational complexity in implementing SDOH assessment processes. The purpose of this article is to discuss the key considerations for organizations interested in designing and implementing SDOH screening and referral programs, especially in primary care or other outpatient settings. Methods: Nine qualitative semi-structured in-depth interviews were conducted with individuals from four health systems in the Greater Boston area participating in the MassHealth Accountable Care Organization program. Interviews were 30-60 minutes long and conducted in-person or by phone. Each interviewee was selected because they played a pivotal role in developing and/or leading social determinants of health screening and referral initiatives within their health system and/or have frontline experience conducting SDOH screenings and referrals within their organization. Interviews were either audio-recorded or detailed notes were taken. Interviews were conducted using a standardized interview guide. Results: Four critical operational elements that health systems must consider when designing a SDOH program include: (1) the depth and breadth of the screening and referral services offered; (2) how new SDOH workflows will integrate into existing clinical pathways and IT systems; (3) the staffing requirements and training needed to support the care team; and (4) how outcomes will be collected and success will be measured over time. Conclusions: Addressing the social needs of patients has tremendous potential to influence the trajectory of their health over time. However, evidence on which social interventions are most effective in improving health and reducing costs is limited. Further research is needed to determine whether SDOH screening and referrals lead to improved outcomes and if so, how best to implement processes to maximize impact.