In a recent study, Humana and the University of California, San Diego sought to identify the social determinants of health (SDOH) that most significantly affect the quality of care and the usage of healthcare services. The study found that SDOHs such as social isolation, limited access to transportation, financial strain, and food insecurity had the biggest impact on healthcare quality and utilization. The study suggests that addressing SDOH through cross-sector collaboration and innovative solutions can lead to a more equitable healthcare system with improved healthcare quality, utilization, and outcomes.
Understanding the role of social determinants of health (SDOH) has become a crucial area of focus for healthcare providers and payers. While the medical community has long recognized the impact of environmental factors on health outcomes, stakeholders are now beginning to prioritize effective interventions to address SDOH.
A recent study conducted by Humana in partnership with experts from the University of California, San Diego, aimed to identify which SDOH has the greatest impact on healthcare quality and utilization. The study focused on over 21,000 Medicare Advantage beneficiaries with type 2 diabetes who completed a health-related social needs (HRSN) survey in 2019.
The study found that over half of the beneficiaries (56.9 percent) reported experiencing at least one SDOH, a higher proportion than that of all Medicare Advantage beneficiaries (49.3 percent). The most commonly reported SDOHs included financial strain, food insecurity, and poor housing quality.
However, not all SDOHs had an equal impact on health and well-being. For instance, poor service quality and high acute care utilization were both associated with social isolation and limited access to mobility. Other SDOHs, such as financial strain and food insecurity, were more closely related to poor care quality, while experiences of loneliness, lack of transportation, utility insecurity, and housing insecurity were linked to lower diabetes medication adherence, a key component of clinical quality.
Food insecurity was also linked to higher rates of emergency department visits, inpatient encounters, and avoidable hospitalizations.
The findings of this study have implications for healthcare organizations, payers, and policymakers as they work to develop effective interventions to address SDOH. The study suggests that understanding the impact of certain SDOHs, such as loneliness and lack of transportation, on both healthcare utilization and care quality can help stakeholders prioritize interventions.
Community-based organizations and health systems can coordinate activities and cross-sector communication to expand opportunities for community members to reduce HRSNs and increase opportunities for healthy lifestyles. Meanwhile, innovative payment models, the incorporation of social supports into the clinical care team, and benefit flexibility for health plans could be helpful on a policy level.
SDOH screening can also have an impact on an individual level. Clinicians and healthcare delivery organizations can use the gathered data to enhance patient care. For instance, for patients who screen positive for an HRSN, practitioners can adjust care decisions to reduce the impact of the unmet need, help connect patients to appropriate social services or advocate for more resources.
A February 2021 patient survey from the Root Cause Coalition found that economic stability and access to quality healthcare are the most common SDOHs, reflecting some of the results of the Humana data. The Coalition’s cross-sector approach is front and center in these findings, with Americans reporting that those responsible for addressing social determinants include federal agencies, all levels of government, as well as health care, public health departments, and community-based organizations.
The study highlights the need for healthcare providers, payers, and policymakers to take a comprehensive approach to addressing SDOH. Effective interventions require cross-sector collaboration and innovative solutions that prioritize the needs of the most vulnerable patients. By addressing SDOH, stakeholders can improve healthcare quality, utilization, and outcomes, leading to healthier communities and a more equitable healthcare system.