The SDOH Movement
In recent years, there has been a growing awareness about the role that social factors play in the health of individuals and communities. It’s likely that the increased awareness has been driven by the increase in incentives to risk-based contracts for hospitals and health systems to promote the overall health of patients and members. In response, the healthcare industry has dedicated significant time, energy and resources to figuring out how to best address social determinants of health (SDOH). Every day new studies and stories are released announcing not only the linkages between social factors and health, but also the growing list of organizations and people making efforts to address them. These efforts range in size and complexity, from United Healthcare announcing that it will dedicate $400 million to improve housing, to community-based initiatives focused on key populations like pregnant mothers, children, and older adults.
As healthcare organizations increase their time and investment to better address SDOH, many want to know if they are taking the correct approach, or how to effectively expand their efforts and get better results. They are looking at a range of things including leadership and staff, social needs screening, population health data, partnerships, programs, and measurement of results. This is a lot to consider and the need to get it right can feel overwhelming, especially because of the furious pace of work in the healthcare space. With the amount of decisions required, just trying to do the right thing is not enough.
We often hear from healthcare leaders who are interested in growing their organizations’ efforts to address SDOH. They frequently note that in order to get support for their work in this area, they need to show that the expenses they put towards addressing social factors need to generate an ROI (return on investment). That means, for example, the money they spend in providing healthy food or assistance with housing will ultimately prevent the people receiving this assistance from getting sick and requiring hospitalizations or other costly services to such an extent that the savings will outweigh the initial costs. (There a number of reasons why ROI in SDOH interventions is a hard thing to “prove,” as it can be difficult to show that specific interventions are preventing costly care. That, however, is a blog post for another day.)
Through these conversations we realized that healthcare organizations need help assembling the right pieces before they can start to analyze ROI. That’s why we created the SDOH Benchmark Assessment.
How we can help
The sausage-making analogy is one of the most widely used in the business world, so we’ll spare you another reference to it. Suffice it to say that in order to create an SDOH methodology that provided value to our clients, we spent a lot of time looking at prevailing models, leveraging our experience in the industry, and an agonizingly long time arguing about the phrasing of questions (we’re still doing that, actually). In the end, our SDOH Benchmark Assessment evaluates healthcare organizations’ efforts in creating and maintaining SDOH programs. We score respondents across four Areas of Focus (see table below) that come together to provide a view of an organization’s strengths and gaps related to addressing the social needs of its members and patients. Respondents are then able to see how these scores stack up against their peer organizations. To provide guidance, Spring Street offers recommendations to respondents on how to improve their scores and adopt practices that the highest performing firms are using.
Some compelling data
Spring Street has received input from over 40 organizations and many of the initial results are compelling. We have seen organizations that have been working on SDOH programs in the communities they service for decades. We’ve also seen organizations that are just starting the process. We wanted to share some now to give you an indication of what we’re seeing under the hood. We think these preliminary findings help highlight how the industry could move forward on SDOH.
When asked if they had an SDOH strategy in place, nearly 50% of respondents said they were planning to create one, while just about 1/3 said that they have already articulated a strategy. To us, this shows that healthcare organizations are thinking enough about SDOH that almost all already have a strategy in place or are planning to create one.
Nearly 3/4 of respondents said they identify the social needs of specific communities they serve. However, there is notable variety among the different internal and external data sets being used. No one standard has emerged.
About 2/3 of respondents indicated that their members’ housing and food needs are much higher priority now than they were before the pandemic. In addition, almost 3/4 said that social isolation was much more of a priority now than before the pandemic began. These numbers are not surprising but are alarming.
Over half the respondents said that less than 10% of their total members were receiving assistance from the plans’ social programs.
About half of respondents said that they track whether their members use services when they are referred to social services organizations. This of course means that about half of the organizations that refer their members out to partners are not checking to see that those services are fulfilled.
Only about 1/4 of respondents have said they have the ability to measure their SDOH programs. Another ~40% said they are developing a process.
These data points are just the tip of the iceberg and would benefit from further analysis and investigation. They highlight just some of the strengths and areas of need that we’re seeing in the aggregate. As we continue to collect new data, we will evolve our model and include additional considerations as they come to light. We’re excited about the effort that is being put toward addressing SDOH and we think the best is yet to come.