Survey Highlights High Prevalence of Social Determinant Challenges, Need to Better Address Them

A new survey from Waystar is providing insight into patient attitudes about social determinants of health (SDoH) and highlighting the need for more targeted, effective strategies for addressing these determinants.

The 2018 Consumer Perspectives on How Social Determinants Impact Clinical Experience report found that 68% of Americans have at least 1 social determinant challenge and 52% have moderate to high SDoH risk in at least 1 SDoH category—financial insecurity, social isolation, housing insecurity, addiction, transportation access, food insecurity, or health literacy.

SDoH challenges proved prevalent across all payer classes, but those on Medicare or Medicaid were more likely to have high stress, with nearly 60% of the combined Medicare—Medicaid community having moderate or high stress in at least 1 category and 33% having high stress in 3 or more. Even among the healthiest consumers, more than 1 in 5 reported higher SDoH risk.

Survey respondents were most likely to report financial insecurity and social isolation as SDoH challenges. While health literacy was the lowest among the Medicare and Medicaid population, food insecurity was the least common issue for those who were commercially insured.

Consumers who reported SDoH stress were more likely to rate their overall health status lower than the overall population and were also more likely to suffer from 1 or more chronic conditions.

Despite a high prevalence of SDoH challenges, the report also revealed that efforts to engage patients on SDoH are often misapplied. According to the report, most conversations about SDoH are occurring with patients who are least likely to have health issues and least likely to utilize support services, if available.

“Organizations are still undervaluing processes within their clinical care to determine these challenges and find support to help improve risk factors for a better, longer-term health outcome for the patient,” said Matt Hawkins, chief executive officer, Waystar, in a statement. “If we are going to take the right steps to promote value-based healthcare, we have to start by addressing the social needs of patients. This starts with talking with care teams on the front lines to better understand the learning gap in understanding SDoH needs of their patients.”

Determining who is responsible for addressing SDoH has remained one of the largest challenges, with the majority of physicians believing they are important and matter to their patients but not believing that it is their responsibility to address them and not feeling well positioned to do so.

Only 22% of consumers with reported SDoH indicated that they had discussed these challenges with their physician, and among high-risk patients, 60% reported having never discussed their issues with a provider or insurance company.

Patients were more likely to prefer discussing their concerns with a physician or nurse than with an insurance representative. “This isn’t surprising but should be considered as providers take on more of a payer role in the form of accountable care organizations, bundles, or simply a greater number of ‘at-risk’ contracts,” wrote the authors of the report.

They also noted that 10% of survey respondents with commercial insurance and 20% of respondents with Medicare or Medicaid said they prefer not to discuss SDoH challenges at all, highlighting the need for strategies for gathering social determinant insights.