Access to a complete picture of the patient – including the behavioral and environmental factors that influence daily health – is critical to realizing the shared benefits of value-based, holistic care.
Across the spectrum of healthcare delivery – payor, provider, vendor, consumer, there is a land rush underway to embrace consumer-centric care. With tools like value-based care, chronic disease management, retail services, analytics, and remote patient monitoring, healthcare organizations are pivoting towards capabilities that provide a deeper understanding of patient behaviors and address the whole patient and not just the condition.
For the industry, it’s a stretch: Healthcare has traditionally been an insular sector, unaccustomed to the kind of broad based, multi-stakeholder cooperation and collaboration that the healthcare consumer increasingly expects.
But access to a complete picture of the patient – including the behavioral and environmental factors that influence daily health – is critical to realizing the shared benefits of value-based, holistic care.
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The challenge extends far beyond service efficiencies that can be gleaned from the patient encounter. Consider: medical care only accounts for between 10% and 20% of health outcomes, whereas the physical environment, social determinants and behavioral factors account for 80% to 90% of outcomes.
More specifically, that 80 percent can be broken down as follows:
- Roughly 40 percent is attributed to socio-economic factors
- 10 percent to physical environment
- 30 percent to health behaviors
Collectively, these factors describe the Social Determinants of Care (“SDOH”), which the World Health Organization defines as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life, including social, behavioral and environmental determinants of health.”
The key areas of SDOH include:
- Economic Stability
- Education
- Social and Community Context
- Health Demographics and Access to Care
- Neighborhood Environment
There is a huge opportunity to close the gaps in care and impact the healthcare outcomes of populations via SDOH – but the challenge is to engage the patient outside traditional healthcare venues. Services delivered in the home and in the community that address environmental issues like housing, income, crime, education, transportation, domestic circumstances and food insecurity have been shown to improve health outcomes and reduce the cost of care.
For example, hospitals can leverage SDOH data to proactively identify and intervene with high risk and vulnerable patients before a health event occurs. Patient engagement and intervention takes on an even greater urgency in a period of population health crisis and system stress – like a pandemic.
The key is to activate SDOH data – to incorporate unstructured, non-traditional health data into the patient record. But SDOH data is often trapped within systems that limit its access, flow and transactional value. It’s a multi-layered problem, beginning with awareness – there is an incomplete understanding of the value and catalogue of SDOH data for clinical care and population health management.
Then there is a data configuration issue -patient matching, terminologies and codes add layers of complexity to the aggregation, distillation and interpretation of SDOH data. And finally the biggest lift – coordinating, at a community level, the social inputs to daily health. That means patient data must flow freely between payers, providers, patients, and community resources.
Source: Healthcare IT News