SDOH Spectrum of Impact

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At Spring Street Exchange, we developed the SDOH Spectrum of Impact framework because we found ourselves articulating this concept so often in meetings and conversation that we decided we needed a visual representation. The discussion of where to focus social interventions is frequently presented in a linear model, starting with point of care and then the shift to moving ‘upstream’ to address social gaps at the root cause. We agree with this trajectory but had also been seeking a way to more clearly represent interventions at different points of impact from the perspective of a health plan or health system.  

The Spectrum of Impact provides five points of impact, each with its own goal(s) and outcomes. They are not arranged in a hierarchical manner because there is a critical need for support at each point. The ideal point for intervention depends upon the organizational strategy and the goal of the initiative. While we share the goal of shifting resources upstream with a preventive focus, there are still social risks and social needs  throughout.  

Point of Care 

Provide immediate relief for pressing social needs during clinical and social interactions of care through either direct services or referral. This includes providing food, transportation, or housing support directly to individuals currently in need. This can also refer to identification of needs at non-clinical intersections, such as at the time of enrollment.   

Actively Managed 

Augment the care for those already receiving support through care management, case workers, or other services to address their social as well as medical needs. 

In Need But Not in Care Management 

Identify those who have health and social care needs or may even be in crisis, but who have some barrier to interacting with the healthcare system. Social analytics can help to identify those who may be falling through the cracks while providing a point of intervention for engagement. Advanced analytics through segmentation and person-centered profiles can help focus supports to those in greatest need.  

At-Risk, Pre-Crisis 

Intervene upstream, before greater health needs emerge. Identify individuals who are at risk for health issues by using social screening and data, partner referrals, and other forms of identification or forecasting.  

Community-level prevention 

Provide support and prevention by addressing social risks and needs at the community level. This could involve housing, food, sanitation, safety, green spaces, and other means of strengthening community health.  

The Political Determinants of Health, by D. E. Dawes

The Political Determinants of Health by Daniel E. Dawes provides a fresh take on a very familiar topic in healthcare—social determinants of health. Dawes takes the position that the social factors that we pinpoint as social determinants of health are often categorized as politically neutral items. Challenges such as poverty, homelessness, housing insecurity, or transportation inaccessibility are external factors that contribute to compromised access to healthcare, but in and of themselves aren’t political. Dawes contests this perspective by asserting that these factors are inherently developed political items in our politically charged society.  And these factors have come about as a direct result of political movements and decisions.  

From this point of view, Dawes provides a history of the quest for health equity in the United States reaching back to the early days of our country. He covers the eras of slavery, post-slavery, the civil rights movement, and continues through to the development of the Affordable Care Act.  

While I'm well versed in the more recent aspects of this narrative, hearing the story of the development of the Affordable Care Act through the perspective of health equity was illuminating. I also found the acknowledgment that these factors contribute deeply to the health status of our population to be refreshing. To that end, social determinants of health are not inherent to life or society but are a result of political decisions that have been made regarding most aspects of our lives. This assessment was especially interesting to me given the current political climate as well as the importance of voting as a political determinant of health. 

This book was well researched and intriguing in the presentation of Dawes’ argument. He is adept at using metaphors to help illustrate his points and uses this literary device to great effect in setting up his narrative as well as his alternative view of society. Throughout this work, the use of metaphor provides insight as to how unjust (and perhaps even unnecessary) some of the political decisions concerning inequality have been.  These are a disservice, not just to the people who are disadvantaged by them, but also to society as a whole.  

I would recommend this book to anyone interested in exploring social determinants of health, as well as those looking to see what steps we can take individually and collectively to reduce the disparities of healthcare. Everyone in this country deserves to have their potential fulfilled and everyone in this country deserves access to a life well-lived. 

Why Do We Focus on Social Drivers of Health (SDOH)?

When I founded Spring Street Exchange (SSX) back in 2016, it was with the goal of bringing a fresh, respectful approach to consulting services in healthcare and also to have the freedom to pursue mission-aligned work. Most of us chose to work in this industry because we want to be part of impacting people’s lives in a positive way. Our goal was to help change the incentives, reduce the insanity, and drive healthcare to be a human-centered, compassionate industry that truly reflects the needs of those it serves. 

In a great collective irony, the industry often defines consumer-driven care in ways that expose patients to more out-of-pocket costs, which many cannot afford. There is nothing consumer-centered about putting patients in a quandary as to whether they should forego care or put off some other critical expense such as rent, food, and utilities.[1]

Any meaningful consumer-centered healthcare needs to embrace a broader definition of care, one which acknowledges the social context of an individual, their personal history, their social circumstances, and the community in which they live. The added benefit for the industry is that, when done well, socially informed healthcare and aligned incentives save money for the system overall.

Looking at healthcare in the context of social drivers of health (SDOH) does not mean fixing all social ills through the healthcare system. Instead, by taking a comprehensive view of individuals, families, and communities, we can work to reduce barriers to health, safety, and well-being and increase accessibility of healthcare diagnosis and treatment.

Addressing social barriers to healthcare is also a critical step in reducing disparities in healthcare. The impacts of poverty are disproportionately experienced by people of color and other historically marginalized populations. Providing social support to bridge this gap is essential on any path to health equity.

Our strategic and operational work has always been about a consumer-centric approach that allows us to align with our values and deliver savings for the industry. In 2018 we started working on our first SDOH Benchmark Assessment, some form of which has now been delivered to over 60 organizations. From here our work expanded to supporting SDOH strategy, market analysis, inventory, program development, and establishing community partnerships.

Our approach is at once visionary and practical. We work with healthcare organizations to establish a common vision, align on values and priorities, and to take a structured and sustainable approach to addressing social needs. Our work is grounded by data and driven by common sense. As a result of our SDOH Benchmark Assessments, we have the only national database documenting the progress payers and providers have been making in addressing SDOH. This intelligence source includes both quantitative and qualitative insight on organizational decisions, challenges, funding, member identification, programs and partnerships, and measurement and outcomes. 

With something as important and fast-moving as the shift to address social needs in healthcare, we need to keep our eyes on long-term ROI and cost-benefit analysis, but we cannot wait for these studies to be complete to take action. Spring Street’s approach to knowledge-sharing and benchmarking brings this insight into the present. This reduces risk and accelerates action.

Our firm’s work in SDOH informs our work in strategic planning and industry transformation. All of the enterprise analysis and strategy work we have undertaken in recent years has included exploring new boundaries of healthcare, whether for scope of service, location of care, and other expanding guard rails.

Our SSX team is on this journey because it is a critical transition needed in healthcare for the lives of individuals needing care, for those working in the healthcare system, and for society as a whole. We stand firm in this quest because of the inspiring work of our industry colleagues – those who have been leading the way for decades and those who are just getting started. The tenacity and creativity fuel us and propel the work forward.

It is an honor for us to tackle these challenges as part of our daily work. Interested in hearing from you – why do you work to address SDOH?

Spring Street Exchange's ACTIONS you can take in 2022 toward better healthcare

As we launch a new year, at Spring Street Exchange we would like to propose seven actions healthcare leaders can take as part of their everyday work to drive positive change in healthcare. While pundits share common summary of trends to watch, we see our role in this dialogue as one of action.  

The actions we suggest cut across trends and are intended to support both immediate work and long-term planning. We recognize the urgent demands and real limitations faced by healthcare leaders who must do more each year with less. And yet, we know that stepping back to look forward can recalibrate and invigorate thinking and shift how we solve near-term problems. 

We hope these ideas resonate with you and look forward to hearing your additions. As always, we are honored to walk alongside you on this journey.  

We’d love to hear your thoughts on any of these. Let’s connect!

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