Building the Evidence Base to Quantify, Communicate the ROI of SDOH Initiatives

Transforming health systems to be able to address social determinants of health (SDOH) requires significant investment into making the systematic change, underscoring the importance of identifying the value of SDOH initiatives. However, while there’s a general consensus that these determinants have a big impact on health, the healthcare system is still working towards a comprehensive evidence base showcasing the benefits of these initiatives.

Moderated by Mary Caffrey, managing editor of The American Journal of Managed Care^®’s Evidence-Based Series, a panel discussion during World Health Care Congress 2019 discussed the importance of quantifying and communicating the return on investment (ROI) of SDOH initiatives.

Before starting initiatives, health systems need appropriate quality measures that take SDOH into account, but according to Christie Teigland, PhD, principal of Health Economics and Advanced Analytics at Avalere, she’s still fighting the fight for incorporating SDOH into these outcomes.

“I don’t think it’s debated anymore that SDOH have an effect on outcomes, but they are not making their way into quality measures,” said Teigland. The reason for this, she said, is because the readily available public data is not granular enough to capture these factors.

In the meantime, growing the evidence base in other ways is key for gaining buy in from providers and payers, and conducting clinical trials is one way to solidify the benefits of these initiatives, explained Jill Feldstein, chief operating officer of Penn Center for Community Health Workers at Penn Medicine, who explained how the health system deployed clinical trials assessing its IMPaCT model.

Through the work of primary care doctors and researchers, the health system interviewed approximately 1500 patients and asked what they thought needed to be focused on for their health. Based on the answers, Penn Medicine designed and deployed the model, which utilizes community health workers to address these needs of patients. By testing the model in 3 randomized clinical trials, the health system was able to provide hard evidence of improved outcomes as a result of the intervention, which led to investment to create the Penn Center for Community Health Workers.

According to Feldstein, a key piece of implementing a model like this is “trying to design a holistic model that doesn’t necessarily presuppose that people are going to need food or transportation or housing, but really thinking about something that can pivot and tailor at the patient level while still having some kind of common infrastructure and standardization that enables you to have economies of scale.”

Something else that’s beginning to show promise is predictive analytics, according to Kate Sommerfield, president of Social Determinants of Health at ProMedica. Thanks to uptake of electronic medical records (EMRs), there’s a level of data that health systems now have access to, allowing the ability to pull commercial, claims, and EMR data to proactively go after patients. For example, among Medicaid moms in Penn Medicine’s system, there’s evidence that 40% of these women have been evicted, which is associated with a 30% higher chance of giving birth to a baby in the newborn intensive care unit.

“Having that level of data allows us to go after our Medicaid moms in a more proactive way and start to secure housing and measure those outcomes over time,” she said.

According to Feldstein, it’s not just endgame outcomes, such as readmissions, that should be tracked, but also process outcomes that build a breadcrumb trail to offer an earlier sense of whether the initiative is working or not, including things like referrals to social service organizations. Susan Mani, MD, vice president of Clinical Transformation and Ambulatory Quality at LifeBridge Health, added that outcomes like potentially avoidable utilization, which focuses on preventing the index admission from happening in the first place, are also useful.

In addition to quantifying the ROI of SDOH initiatives, health systems also need to be able to communicate this benefit. Through LifeBridge Health’s experience with SDOH, Mani explained how patient stories have emerged as an effective way to do so.

“A few years ago, my clinicians didn’t understand the term SDOH, but they did know is ‘how come my patients aren’t taking the medications I told them to take?’” said Mani. By taking patient stories to those providers and have them realize the importance of SDOH and asking the right questions, they were able to get buy in from those providers.

To get buy in from payers, Mani recommended making a business case by putting money amounts behind measures, such as prevented readmissions and prevented index admissions. “if you are starting a service line in cardiology, orthopedics, wouldn’t you think about it from a business case perspective?” she said. “Why would we think about population health any differently?”