Health care, health equity and social determinants of health

November 2, 2020 / By Katie Christensen

Social determinants of health. If we didn’t know the phrase before the COVID-19 pandemic, we have probably heard it by now. It refers to underlying factors that indirectly explain 90 percent of our health outcomes. Here is a great explanation of the concept from Sanne Magnan, MD, PhD, of Health Partners Institute:

“Medical care is estimated to account for only 10-20 percent of the modifiable contributors to healthy outcomes for a population. The other 80 to 90 percent are sometimes broadly called the SDoH: health-related behaviors, socioeconomic factors, and environmental factors.”

What does this phrase mean in practice? As I was recently reminded by a care coordinator:

“We know that if our member’s social needs aren’t met, their medical needs won’t be met either.”

These unpleasant truths represent the harsh realities facing our community at large. For many, it means:

  • Lacking transportation to medical appointments
  • Inability to take time off from work to see the doctor
  • Feeling intimidated at the pharmacy because of language barriers.
  • Not understanding a care plan or the implications if it is not followed.
  • Not having the means or access to healthy food options.
  • Not having a warm bed at night, or any housing at all.

The thing is, you can only delay for so long before acute onset of medical problems occurs. This is why health care providers believe in “well visits” and screenings. This is why we are supposed to see our provider on a regular basis. 

And what does it mean to offer equitable health care if you are at a disadvantage for participating in the first place? It’s like buying a car but you can never change the oil, or it can only be serviced by a dealer 100 miles away. Forgive the analogy, but eventually the car (or person) is going to break down from an inability to be serviced or see a doctor.

Here at 3M, we are in the process of exploring how analytics can leverage social risk with clinical risk to achieve better health and better outcomes.

You may already know about us from our established Clinical Risk Group (CRG) methodology, which allows identification of chronic health plan members en masse without having to know the individual ICD-10 diagnosis codes to target both individual care management and community outreach more systematically.

What does the data show?

There is some evidence that greater clinical risk is correlated with greater social risk. The specific risk factors vary: transportation, food, health literacy, etc. We are also seeing some early indications that health plan members with greater social risk have higher rates of emergency room utilization, even after adjusting for clinical risk. 

We already know that we need to more closely manage our populations facing chronic disease and therefore greater clinical risk. Now we are seeing the data that supports the social half of the equation. We have just scratched the surface, but I am optimistic about a future where programs that address social determinants of health are a standard component of high quality care delivery.

Katie Christensen is a healthcare consulting manager within the Population and Payment Solutions group of 3M Health Information Systems.