At Healthcare Innovation’s Southern California Summit, held May 2-3 at the Hyatt Regency La Jolla at Aventine in the San Diego suburb of La Jolla, a panel discussion on May 2 entitled “On the Leading Edge: The Role of SDOH Strategies in Population Health,” featured Tracy Elmer, chief innovation officer, TrueCare; Joon Lee, M.P.H., chief population health officer, Palomar Health Medical Group; Robert Pretzlaff, M.D., senior vice president, chief medical officer and chief clinical officer, Henry Mayo Newhall Hospital; and Kussy Mackenzie, healthcare strategist, UC San Diego Health, Strategy Office. The panel was moderated by Mark Hagland, Editor-in-Chief, Healthcare Innovation.
Hagland began the discussion by asking his panelists for a 40,000-foot view of social determinants of health (SDOH) and how the healthcare system is moving forward. Mackenzie said, “Folks have been addressing SDOH for decades and decades, but the pandemic brought rising inequities to the surface.” She explained that in her system she already has a lot of people helping her with SDOH work. One of the main focus areas and projects that her organization is looking at now within the health system is bringing community resources to a platform into their EHR system. She asserted that the platform is just a tool, not the answer, but the tool is helping their social workers and case managers actually ask the important questions face-to-face with their patients. It’s also helping with a more optimized way of making a referral and doing screenings. She added that they need to build out more formal relationships with community organizations that are actually providing social needs—its about combining existing resources and expertise.
Hagland then asked his panelists when looking at this landscape, what they see as a few of the clearest ways to move forward quickly. “You have to move with intention,” Elmer commented. “We have a strategic plan that has a specific set of objectives around this area. We rely on our community partnerships to advance toward better outcomes. I think we also have to move a little faster at times when a strategy is usually defined to take years. We've built in a framework and some specific goals. And we, as an FQHC [Federally Qualified Health Center], are subjected to submitting data to HRSA [Health Resources and Services Administration] every year, it's called the uniform data set (UDS). That's what tells our story, and it is data oriented. We also do a needs-based assessment survey, and really use that to drive our focus. One of the things we talked about last year as we put a framework together, is that there's so many factors and social barriers to care. For us right now, the pandemic has worsened things, certainly the divide is larger. We're trying to get folks back in for general care, our primary purpose is prevention. Immunizations, for example, of children is a huge area where we have seen such a dramatic shift and decline. We have, by intention, focused on certain patient groups, but also certain areas of SDOH. For us, it's food security and homelessness. Again, it’s defining goals within our strategic framework around expanding our partnerships in those domains, trying to integrate it, trying to create that referral workflow and process, so when you see the patient, you're connecting with the patient.”
Lee said, “I think with social determinants of health, it's a bit of a challenge. It's kind of early on, and we're still trying to define [things]. I think the first thing for us is around awareness, just being able to have a group of colleagues and leaders to engage people into the conversations. What kind of questions do we want to ask? What kind of answers do we want to figure out? What are the disparities that we think exist? And then, what are the ones that are the ‘a-ha’ through that data set? Then [you ask] whether it's a dashboard or whether you take a different cross section, and then you say, ‘Oh, this is something we didn't realize until we looked at the data.’”
“Right now, at Palomar Health we're early on,” Lee added. “And one of the things that we're looking into is an ACO population health platform that actually addresses social determinants.” He goes on to explain that the platform the organization is currently looking at has a social determinants index. It identifies who is more vulnerable than others through a series of questions. When an individual is taking the survey in the platform, the AI that is integrated immediately triggers an alert if there is a social determinant need before the data is parceled out. The index also connects with care management and has certain algorithms, it may not be perfect according to Lee, but it gives some actionable items to take care of that member.
Hagland then asks the panelists where they think healthcare needs to start first regarding SDOH. Pretzlaff replied, “We've moved some ways in population health, I think we probably have not moved as far as you would like to believe [regarding SDOH]. I remember clearly in a job only a couple of years ago in Nevada, presenting this brilliant plan for our medical group in our ACO to decrease emergency room visits. And the CFO looked at me across the table and said, ‘Why would you want to do that? There's absolutely no reason to decrease emergency room visits, since it's one of the two areas of our hospital that are loss leaders.’ As we're moving forward, one of the things that we can get out of this with regard to social determinants is that there's data out there. Not all of it is actionable. I've spent most of my life in the four walls of a hospital. For those of us who live in the four walls of the hospital, we actually don't believe there's life outside. When I was working in New Jersey, with a very large CIN ACO, as it was statewide, we had a few 100 providers, and we were implementing our SDOH plan. One of the first things that we needed to do is really go out looking to [the] community and find those partners that already exist out there in order to implement. I sat in a lot of meetings where we talked about transportation, housing, insecurity, and food insecurity. And within the walls of the hospital, we kept thinking that we had to create these things for ourselves. But what we really needed to do is look outside the four walls, find those partners, because there isn't the money within the healthcare system to address the SDOH.”
Hagland then asked Mackenzie how to make these kinds of connections and how to do it ‘right.’ She commented, “I can tell you what we're planning on doing. Right now, we’re trying to optimize how we're doing the screening and referrals for social needs—that's one part within the hospital wall. The second part is connecting the community’s organizations and really being intentional about creating value for the community’s organization as social-needs providers. What I mean by that is, it's such a struggle, and especially researchers know [this] as well is, going from grant to grant to grant to grant, it's exhausting. How do we move beyond that and go beyond transactional relationships with our community organizations and make it like contract? And how do we do equitable contracting so there's a better flow of funds for these organizations? How do we help them with business intelligence? For example, supplying some of these tools that we use for our clinics and helping them like, ‘Hey, this is how you use a Healthy Places Index, to understand your communities and the people that you serve.’”
Hagland then asks Lee if perhaps SDOH can be done on a national level. “That’s a hard question, I think that I would like to say yes but the challenge is what factors do we home in on?” Lee responded. “What is it that we're going to narrow down into, how are we going to learn? I think the first part is just gathering as much data as possible, quite honestly. Then at a certain point, like with population health was, you kind of figure out that it deals with the complex nature of chronic conditions with the patient population surrounding quality and then cost containment. Now we can articulate it much better than before. I think that that's the tough part with social determinants. Everyone's taking swings at the bat, which I think is great. From a national perspective, we should encourage people to take action. Then going back to a point we made earlier today, the challenge we have is that there is no financial support to begin the process. That’s true, so that’s a tough point.”
