Examining social determinants of health (SDOH) and how they affect certain populations is nothing new for healthcare providers and payers. Some providers are investing in additional staff and other resources to zero in on SDOH to improve health outcomes, reduce emergency department and inpatient care visits, decrease downstream medical costs, and maximize clinical quality. A recent study found that more than 80 percent of payers are integrating SDOH into their member programs.
As we’ve mentioned in previous blogs, the World Health Organization (WHO) defines social determinants of health as “the conditions in which people are born, grow, live, work and age and circumstances that are shaped by the distribution of money, power and resources at global, national and local levels.” SDOH affect many individuals’ abilities to obtain appropriate healthcare services, as shown in the following statistics:
- Rates of preventable, chronic diseases are rising in low-income communities.
- Studies have found that individual behavior, often spurred by SDOH, accounts for up to 40 percent of the risks for premature death.
- The average life expectancy in low-income communities is 15-20 years shorter than those in higher-income communities.
- The U.S. spends less on social services than any other developed nation, ranking twenty-third out of 24 developed nations.
- Research shows that clinical care accounts for only 20 percent of health outcomes; the rest is determined by socioeconomic, behavioral, and environmental factors.
The COVID-19 Pandemic’s Effect on SDOH
The COVID-19 pandemic exacerbated already existing health disparities for a broad range of populations, but specifically for people of color. People who are homeless were at higher risk of viral transmission because of crowded living spaces and scarce access to COVID-19 screening and testing facilities. Also, as realized during the virus outbreak, poor communities suffer more than their more affluent counterparts during a pandemic.
The COVID-19 pandemic highlighted the need for payers and providers to improve patient outcomes by deploying alternative patient outreach strategies that allow them to care for patients experiencing healthcare disparities in their communities, homes, and jobs. Read on to learn about three types of SDOH that can be addressed using patient outreach.
1. Life Necessities
Individuals who experience challenges meeting basic needs like nutrition, shelter, and safety are more likely to report having poor health. The items are defined as necessities of life and consist of anything that’s a prerequisite to survival and a deterrent to premature death.
Before the COVID-19 pandemic, approximately 580,000 individuals in the United States – about 18 out of every 10,000 people – were experiencing homelessness on a given night. Almost 40 percent of these people were Black. Children account for 18 percent of homeless people, and almost half of the entire U.S. homeless community lives in California.
Shelter isn’t the only life necessity affected by the COVID-19 outbreak. Roughly 10 percent of all adults in the U.S. reported that their household sometimes or often didn’t have enough to eat. Food hardship remains substantially higher than before the pandemic, with adults being at least twice as likely to report lacking sufficient food than in 2019.
Without access to some of life’s essentials, it’s no wonder scheduling doctor visits isn’t top of my mind for these individuals. Instead, they’re focused on caring for their family’s immediate needs, including what they’ll put on the table for dinner or where they’ll sleep at night.
To improve the health and wellness of these patients, healthcare payers and providers need to first understand their individual needs and subsequently conduct patient outreach by directing them to relevant resources that can meet those needs.
For example, patients identified as food insecure are considered to be at an increased risk of developing chronic diseases, including obesity and diabetes. To combat this, payers and providers can tailor patient outreach programs that offer supplementary food assistance, dietary education, and nutrition programs.
In addition to life necessities, access to reliable and convenient transportation is important for helping patients receive the medical care they need. However, the American Hospital Association notes that 3.6 million individuals experience transportation barriers that prevent them from accessing medical care. Transportation barriers can be a result of a variety of factors, including:
- Living geographically distant from healthcare services
- Not possessing a driver’s license
- Not having access to a working vehicle
- Being unable to drive due to a physical, cognitive, or mental limitation
- Not having enough finances for costs associated with transportation options
To combat these limitations, many healthcare organizations are establishing relationships with popular rideshare transportation services such as Uber and Lyft. During the pandemic, the White House announced that anyone needing a ride to get a COVID-19 vaccine shot was able to get a free trip from both of these ride-sharing companies through July 4.
For other medical care, providers can leverage two-way text messaging to conduct patient outreach to patients who need a ride to scheduled appointments. If patients respond ‘yes’, these solutions automatically generate a ride offer via text, letting the patient know when his or her ride will arrive. This enables them to be on time for their healthcare appointment. After the appointment, returning home can be just as easy with automated communications systematically scheduling patients a ride based on when is convenient for them. Proactively offering transportation options via patient outreach eliminates the need for patients to worry about their ride, so they can focus on making healthy choices that are within their control.
3. Financial Stress
Financial stress is a major barrier to good health and can be impacted by a patient’s employment, income, expenses, debt, medical bills, and support. U.S. adults are more likely to report financial barriers to healthcare compared to other countries.
Patients experiencing financial stress may be less likely to show up for scheduled appointments and procedures out of fear they won’t be able to pay for the services. As a result, they may experience poorer health outcomes for diseases that could have been avoided.
The U.S. Census Bureau’s Household Pulse Survey indicates how the COVID-19 pandemic continues to financially affect individuals across the country:
- Nearly one in five adults reported that they or someone in their household had experienced a loss of employment income in the past four weeks, and one in ten applied for Unemployment Insurance benefits in the past four weeks.
- More than half of adults reported difficulty paying for usual household expenses in the past seven days, and 26 percent used credit cards or loans to meet household spending needs.
- Six percent of adults had no confidence in their ability to make next month’s housing payment, and nine percent reported food insufficiency in their household.
- Nearly one in five adults reported delaying medical care in the last four weeks due to the pandemic, and more than three in ten adults reported symptoms of depression or anxiety.
According to the Center on Budget and Policy Priorities, the impacts of the pandemic and the economic fallout have been widespread but remain particularly prevalent among Black and Latino adults and other people of color.
As a remedy, healthcare payers and providers can conduct patient outreach targeting populations identified as low-income to offer cost-effective alternatives for otherwise costly services. For example, being able to identify patients who may not be able to afford rising medication prices can help providers and payers think through budget-friendly alternatives, including how and where patients can buy generic alternatives.