Visualizing the Role of Social Determinants in Clinical Care

A simple model can help health systems incorporate the social determinants of health into their clinical programs, according to presenters at the National Association of Managed Care Physicians Fall Managed Care Forum 2017.

Edwin Choi, MA, UI/UX designer, Involution Studios, presented the fundamentals of the diagram he helped develop, which displays the 5 determinant categories of health and their many components in concentric rings. The size of each “slice” of the round chart represents how strongly the category is associated with an individual’s health outcomes, and medical care only accounted for 11%.

Instead, individual behavior and social circumstances comprised much larger proportions, at 38% and 23%, respectively. The behavior category includes macrodeterminants like psychological assets, drug use, and physical activity, which are further broken down into microdeterminants. The chart also includes the suggested methods for data collection on each of the 95 total components.

Choi explained that the diagram was created by asking different health systems what elements they considered essential to include in patient records, then supporting these components with research by academic institutions, nonprofits, and government agencies. The goal of the visualization was to depict the “spider web of interactions” in a way that is touchable and interactive and allows stakeholders to imagine how different determinants can align.

By offering a greater depth of data, health systems can use the tool to steer their programs in a more value-based, holistic direction. The visual’s main purpose, Choi summarized, is “to help promote the idea that healthcare has a lot of factors involved, and a lot of what we see now is too focused on the medical side.”

Next, Deborah Keller, RN, BSN, CMCN, chief operating officer, TCS Healthcare Technologies, shared how the visualization inspired her to integrate the determinants of health into the care management solutions her organization provides. She cited the importance of having a team that buys into the idea that social aspects make a difference, and highlighted the contributions of social workers and nonclinical coordinators on those teams.

“Many hands make light work, and these are important hands to have,” she said.

Keller also praised the creative ways some of her managed care clients have addressed social determinants at crucial points in the healthcare journey. For instance, one offered its employees the chance to wear jeans to work once a week in exchange for contributing $1; the money raised was used to throw a monthly baby shower for high-risk pregnant members, who received cake, gifts, diapers, and educational packets.

She advised health systems to create a single question to ask themselves and their members during each encounter, like “Has this member benefitted from my actions?” for self-evaluation or “What am I not asking that I should be?” to a patient. These “always ask” questions can continuously drive organizations to improve.

Finally, Jonathan Burke, DO, CHCWM, medical director, Populytics, Inc, gave his perspective on the social determinants of health in clinical practice. As an osteopath, he was trained to treat the whole patient and consider the links between the mind, body, and spirit, and he carries those principles into his role in care coordination for the population health management and analytics firm Populytics, which is affiliated with a provider network.

The care coordination efforts he oversees include health coaches who work with members to understand health goals and develop strategies for success that often relate to the behaviors in Choi’s determinant model. He also discussed the ongoing shift from the mindset of disease management, which focused on medical care and clinical conditions, towards condition support, which looks at the individual as a whole. The patient engagement rate has improved significantly under this approach, Burke noted.

Looking forward, the provider network is looking into community health initiatives that will include the rest of the determinants in the model and “bring the other things that impact health into the clinical encounter,” he concluded.