Social determinants of health, or SDOH, are the societal, economic, and demographic-related factors that may affect a person’s health. The U.S. Department of Health and Human Services breaks social determinants into five categories:
- Economic stability
- Education access and quality
- Health care access and quality
- Neighborhood and built environments
- Social and community context
By considering how each SDOH affects a member’s daily life, health outcomes, and managed care costs, we can determine ways to address SDOH and reduce costs on both an individual and a collective basis. Additionally, by examining the roles caregivers play in improving SDOH, managed care organizations (MCOs) and providers can work as partners to improve outcomes for members.
Economic stability is intrinsically tied to health and well-being in many ways. Financial concerns are linked to stress, which plays a key role in mental and physical health. A study from the American Psychological Association reported that 72% of Americans said they felt stressed about money at least some of the time in the past month. Stress can contribute to heart disease and diabetes. It may also weaken our immune system and prevent us from fighting off disease as easily.
Additionally, economic instability might make it harder for people to exercise, eat well, or do many of the things that contribute to better health. A study from the CDC discovered that greater percentages of people in states with higher median incomes meet the minimum recommended federal guidelines for physical activity not related to work. In other words, people who have higher incomes tend to work out more. They may have access to workout equipment, gym memberships, and even extra free time that those living at or near poverty level may not have.
Payers may reduce the inequity inherent in health outcomes for lower income patients by negotiating group discounts for at-home health equipment or gym memberships, reimbursing transportation to gyms, and offering other discounts and benefits at affordable rates.
Caregivers can encourage the use of at-home workout videos and introduce patients to online fitness communities for support and motivation. Best of all, MCOs and providers can take these steps with very few costs.
Health Care Access and Quality
Healthcare access ties into economic stability in many ways. At the most basic level, people who are short on money may not be able to afford co-pays for healthcare if they are sick, may not have access to healthcare at all, and may skip preventative healthcare due to lack of access, lack of money, or even lack of transportation.
MCOs can make a difference by managing costs and ensuring patients get the care they need regardless of financial status; working with caregivers to provide transportation or cover transportation costs; and ensuring caregivers take a proactive role in preventative medicine, which can reduce healthcare costs for all. The CDC notes that preventable chronic diseases account for 75% of all U.S. healthcare costs, while costing the country $260 billion per year in reduced economic output.
Caregivers can monitor mental health, blood pressure, heart rate and even – through the use of wearables – sleep and oxygen levels. Using our Care Insights tool, they can record changes in member condition and report them back to their agency so the agency can address any potential issues before they get worse.
Education Access and Quality
Just as higher income individuals make leisure workout activities a priority, they might also be better educated on other steps to take toward better health – including eating healthy foods, moderating alcohol intake, and avoiding smoking or vaping.
In many cases, poor eating habits are not a result of low income, as fast food can be pricier than fresh vegetables. It is often more a matter of time and knowledge to select and prepare healthy foods.
Proactive education about preventative health and healthy activities can improve outcomes for patients. Caregivers can provide nourishing meals and model behavior that can help patients lead a healthier lifestyle. Preventing diabetes alone could reduce U.S. healthcare costs by 25%, the CDC says. It is the most expensive chronic condition in the country, accounting for $247 billion in direct medical costs and $90 billion for lost productivity.
Neighborhood and Built Environments
If you are starting to think that SDOH point back to income, food, and exercise, you are right. And these factors are closely tied to the neighborhoods where people live. The more grocery stores in a neighborhood, the lower the residents’ blood pressure and body mass index (BMI), on average. The more fast food restaurants in close proximity, on the other hand, the higher the average BMI for the neighborhood, according to research from the Oregon Health Study.
Built environments, which refer to where a person lives and the surrounding structures in the neighborhood, also point to the accessibility of clean drinking water, the absence of lead in homes, and the absence of mold and pollutants. If caregivers notice any of these environmental factors, they should report it to the agency immediately.
Again, MCOs and caregivers, alike, can offer education regarding smart food and fitness choices, and work to make it easier for residents to make healthier decisions.
Social and Community Context
The social support network and the community a person has around them can also be a determinant of health. People who feel supported and have a “village” to help them may experience lower stress which, in turn, reduces the risk of many diseases.
Caregivers are in a unique position to provide social support where it may not previously exist. They can provide companionship, a listening ear, games and diversions from the boredom of life at home or in a facility.
Similarly, MCOs can seek to provide members with social outlets via online communities, access to free telehealth counseling, and mental health education, including materials that can showcase the warning signs of stress or poor mental health.
Additionally, home health aides can use technology to report changes in mental health that may indicate disorders such as depression so the patient can get help faster. The social and community aspects of SDOH may, in fact, be one of the most important and the least costly to address. With strong community support, it’s easier to address other SDOH, from education and exercise to economic insecurity and access to healthy foods.
Additional Steps to Improve SDOH
MCOs and providers can look to community programs to assist in addressing SDOH. First, examine where the greatest need exists amongst your member base. Is affordable housing a problem? Food insecurity? Access to preventative medicine?
Research rideshare programs such as Lyft for Healthcare, which the company says can reduce costs by an average of 32% and improve satisfaction for 80% of your members. Connect with volunteer programs such as food pantries to help meet the needs of your members. Look into meal delivery and shopping services that could make it easier for your members to choose healthier food options.
Building a strong, connected, and healthier community can begin with MCOs and providers. Once you realize the important role SDOH play in patient outcomes and managing costs, you can begin to create a strategy that addresses some of the most pressing issues within the communities you serve. Although SDOH are, literally, social determinants of health, they do not need to determine member outcomes. Instead, they serve as roadmarkers or indicators of issues that need attention in order to improve health outcomes for various demographics.