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Addressing social determinants of health to improve community care

July 08, 2020
From the July 2020 issue of HealthCare Business News magazine

By Valerie Dimond

Value-based healthcare delivery requires identifying social determinants of health among certain patient populations.
Issues such as food insecurity, lack of affordable housing, transportation, childcare, mental illness, and substance use, for example, have been linked to poor physical health and overutilization of healthcare services. Consequently, some healthcare systems are starting to tackle the barriers to quality care with a variety of programs.

“It’s been a topic widespread for 10 to 15 years now, but I think in the last two years it’s definitely taken off in terms of implementation,” said Dr. James Schuster, associate chief medical officer and senior vice president of medical and behavioral services for UPMC Insurance Services division in Pittsburgh.

Yet, some report little progress after implementing interventional programs, including researchers in New Jersey who conducted a study published in January in the New England Journal of Medicine. They compared two groups of patients with very high utilization of healthcare services — an intervention group that received care-transition support that addressed social detriments of health and a control group that received usual care. The researchers tracked hospital readmissions within 180 days after discharge and concluded that there was no difference in readmission rates between the two groups.

But Schuster, who also provides oversight and leadership at the UPMC Center for High-Value Health Care, and his colleagues, feel strongly about the benefits of employing detriments of health interventions and recently penned a letter to the journal’s editor explaining why.

“We thought the scope was probably too narrow and too short-term. They really looked at only 30-day readmissions during the six-month period,” said Schuster. “Work that we’ve done — and it’s had a similar theme — none of it really shows a financial return in the first six months. If you’re really trying to get people engaged in treatment, and address their psychosocial challenges, it takes a while to have an impact.

Typically, the results aren’t seen until the second or even third year of intervention. Looking at hospital readmissions is clearly an important metric but it’s not the only metric that you’re necessarily addressing in the short term. What you’re really trying to see [is] are people getting engaged in care, are the rates of preventive screenings going up, are they getting their meds filled, is their housing more stable? You’re really looking at more systemic measures of ongoing health as opposed to one specific medical metric.”

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