Experts Detail the Investments Necessary to Tackle Social Determinants of Health

Investing in certain areas of patient care is a necessity when it comes to addressing social determinants of health (SDOH), emphasized health experts during a webinar hosted by NEJM Catalyst Thursday called “Social Needs and SDOH: Impact on Patients and Communities.”

During the webinar, 3 speakers discussed investments that will need to be made to effectively address SDOH:

• Caroline Fichtenberg, PhD, codirector, Social Interventions Research and Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco
• Nichola Davis, MD, MS, vice president and chief population health officer, Office of Ambulatory Care and Population Health, New York City Health + Hospitals, and clinical professor, Department of Population Health, NYU School of Medicine
• Erin McAleer, MSW, president and CEO, Project Bread

Fichtenberg talked about how investing in staff to help patients gain access to resources doesn’t have to encompass just 1 type of professional or person, and she highlighted how community health worker models have gathered great evidence bases. She went on to say that research indicates that having someone available to help a patient navigate the system is “crucial.” She also recommended paying for social services and addressing social needs by providing the needed resources.

“We are seeing this play out very compellingly in the medically tailored meals space, where rigorous research is showing an average [of] about [a] 50% decrease in hospitalization and about [a] 20% reduction in annual health care expenditures by providing medically tailored meals to individuals who have chronic conditions that are diet sensitive.”

Next, she highlighted investing at the community level to help address factors like affordable housing or food deserts, and she argued that working on the individual level will only go so far, but community investment can integrate prevention of social needs.

Then, she underscored the importance of involving experts in these endeavors and not taking on the burden of addressing social needs single-handedly.

Davis then spoke on what she has implemented at Health + Hospitals. The system uses a screening tool by integrating a social needs referral platform into its documentation. Currently, food insecurity and medical legal assistance are 2 services her organization offers, after they expanded their staff. This includes a network of social workers and case managers who address complex needs and over 250 community health workers and supervisors who work in ambulatory, adult, pediatric, and behavioral health clinics.

“We need to elevate social health to the same status as physical health,” she emphasized.

She also explained that what happens in the doctor’s office only accounts for about 20% of someone’s overall health, and that SDOH and patient health behaviors contribute much more to health outcomes.

McAleer next discussed the issue of hunger and integrating food access into health care.

“It’s a systemic issue, but responses tend to focus on individual solutions to hunger,” she said.

She went on to say that she believes the health care system is an important access point for conversations around nutrition and food resources and acknowledged that addressing food insecurity might feel like an additional burden for health care providers. Further, she noted how she hears from physicians regularly who say they’re reluctant to screen for food insecurity because if they discover that a patient is food insecure, they won’t know what to do. She argued that physicians should have an easy way of referring patients for support and cited emerging models that are starting to connect health care institutions to community-based organizations (CBOs).

From doing this work in her organization for 7 years, she’s learned that these models work. It’s more effective to partner with CBOs that have expertise in food access than to try to develop internal programs at a health care institution, she explained. Patients need tools and resources to purchase and prepare healthy food in a sustainable way; however, CBOs and health care institutions working together will take time and effort. She went on to say that a Medicaid waiver is currently the most promising payment model for this system.

“I think that the only way to get there is to demonstrate the cost savings directly attributed to the improved health outcomes.”

Reference

Beach MC, Berkowitz SA, Davis N, et al. Social needs and SDOH: impact on patients & communities. NEJM Catalyst webinar. March 9, 2023. Accessed March 9, 2023. https://events.catalyst.nejm.org/events/social-needs-and-sdoh-impact-on-patients-communities