Where you grew up… where you went to school... your access to nutritious food, reliable transportation and secure housing… aspects of everyday life like these—known as social determinants of health—can contribute to 70% of your health and wellness outcomes.
As we continue to learn more about the importance of addressing social risks to provide better care for vulnerable populations, creating a plan of action is crucial to providing more holistic care for every individual, everywhere. Here are three crucial components that should be included in that action plan.
Food and housing are not only basic human needs, but they also play a major role in determining health outcomes.
In Perth, Western Australia, a study on poor health outcomes in the homeless found that 71% of homeless individuals had visited the emergency department within the previous six months. Multiple resources were leveraged in this study—including the Vulnerability Index – Service Prioritization Decision Assistance Tool—in efforts to uncover contributing factors to poor health outcomes among this patient population.
One use case highlighted in the study detailed the health story of a 35-year-old man who presented as high risk for poor health outcomes. He had no stable living accommodations for 10 years and was sleeping on the street. His first interaction with a healthcare system was at age 22, when he was treated for severe injuries after being hit by a car. In the years to follow, he experienced additional injuries that left him permanently wheelchair-bound. His lack of mobility and other factors increased the dangers he faced every day. When asked what he would need to improve his safety, his response was simple: “A house.”
The U.S. reports approximately 200,000 individuals living unsheltered and on the streets throughout the country—though due to challenges with the methodology for compiling this data, it’s likely this number is much higher. This is just one of many challenges associated with health inequity and the resulting barriers faced by individuals everywhere.
Community programs have proven to be successful in acknowledging the connection between housing security and health outcomes. One example is a program by the University of Illinois in the U.S., Better Health Through Housing, formed with the goal of getting more people off the streets and into permanent housing. They found that once individuals were provided with permanent housing, their healthcare costs dropped nearly 20%.
It’s no secret that improving health and wellness outcomes depends on access to healthcare resources, tools and services. Because every individual faces their own unique health challenges, there’s no one-size-fits-all solution that makes sense for everyone’s needs.
Azizi Seixas, assistant professor of the Department of Population Health and the Center for Healthful Behavior Change at New York University School of Medicine, says this means we need to personalize our approach in risk assessment at the individual level as much as possible in order to better care for those most negatively impacted by social determinants of health.
“There’s a difference between the haves, have nots and the have mores—and we recognize that in healthcare,” Seixas told HIMSS TV. “What we’re trying to do is tackle those individuals who may not have ready, fingertip access to healthcare. We want to be able to help them to better assess their risk.”
Seixas talks about closing the health access gap with risk assessment tools in this HIMSS TV interview.
Making risk assessments more readily available to all individuals so they can get the care they need is an area that Seixas is particularly focused on.
“The big picture is… personalized population health that allows us to discover where we can actually look at DNA and other biological factors that actually cause risk that might be different across different people because we’re all so heterogeneous,” he explained. “It can also provide personalized solutions that allow us to actually help people. To be able to be more aware. To assess. To get the necessary treatment so they can better adhere. That’s the big vision.”
Leveraging the power of social determinants data is also key to providing better care, but a lack of billing codes makes it difficult for providers to document.
One study across three community health centers caring for more than 20 million high-risk populations in the U.S. aimed to uncover the provider’s ability to address health equity in care delivery. Over a four-week period, nearly 2,000 social factors were identified during appointments. Only 1% of factors were associated with existing billing codes. This speaks to the major challenges that exist in integrating these factors into care delivery.
“While initiatives do exist, an agreed-upon confluence between social determinants criteria and standards such as the ICD-10 codes has yet to be established,” said Madelynn Valu, MPH, RD, program manager, informatics, HIMSS. “Perceived neighborhood safety or threat of environmental violence, which could greatly impact a person’s psychological health and ability to access healthcare, is not clearly matched to an ICD-10 code.” Limited access to transportation, a common challenge for people everywhere, also lacks an ICD-10 code, she added. Language barriers are another common social determinant unaddressed by ICD-10 codes.
Without consistent data to analyze, many of the biggest challenges facing health and wellness will remain unresolved. “Having consistent data will lead to better research, identify new reimbursement payment models, optimize how population health management programs are designed and increase coordination of care within a team-based, patient-centered care setting,” said Ian Hoffberg, applied innovation manager, HIMSS. “It is imperative that we establish these standards today so we can move forward together in the development of technologies and adopt a culture of awareness that is empathetic to our patients and providers.”
Amplifying awareness and continuing the conversation is essential in order to break down barriers contributing to health inequity—so that every individual everywhere has a fair chance at achieving their maximum health and wellness potential.
March 9 – 13, 2020 | Orange County Convention Center | Orlando, Florida
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