Who Are the Key Players in Social Determinants of Health Strategy?

As healthcare organizations continue to target the social determinants of health, they must collaborate with other key players to deliver on programs.

 - The healthcare industry has come to a consensus that the social determinants of health and population health are essential considerations for delivering value-based care. But it takes a village, as the adage says, and organizations need to anticipate a number of stakeholders for making these programs a reality.

SDOH programs are inherently multi-stakeholder — they require the medical provider who will identify high-risk patients, fund sources, care coordinators or caseworkers, and the community-based partners that will help carry out interventions. Each of these stakeholders needs to be working in the same direction in order for programs to be successful.

Some hospital boards have already considered the SDH and how hospitals can effect change in SDOH for prospective patients.  The question being "Is there a return of investment? "Will this lower the direct cost of health care?

READ MORE: How Addressing Social Determinants of Health Cuts Healthcare Costs

Nutrition programs, housing initiatives, and ridesharing partnerships are some of the ways providers are reducing healthcare costs by addressing social determinants of health.

And as a fundamental part of that duty, board members are considering where to allocate financial resources to fund SDOH programming.

Adjusting Medicaid Payments for Social Determinants to Boost Care

Using a per-person adjustment for Medicaid payments to hospitals would address social determinants of health and help hospitals fund more comprehensive care, experts say. While some hospitals and organizations have outreach programs to increase accessibility for higher risk groups, this approach is to directly influence  SDH by other means. Some of these programs are already funded by other organizations, non-profits, food banks, homelessness programs. Hospitals can be a source of information as well.  Emergency room demographics reveal the data on homelessness, substandard housing, and poor nutrition. Substance abuse organizations can network with hospitals to deliver this information as well.  Emergency rooms function as social crisis centers. Public health and federally qualified health centers are organized centers of SDOH information. The information is already in place from Medicare and county hospitals.

READ MORE: How Food Security Programs Target Social Determinants of Health

How Social Risk Factors Influence Value-Based Reimbursement

The AHA (American Hospital Association) recommends that provider organizations take the following steps to implement similar housing initiatives:

Identify issues, opportunities, and risk
Establish strategic partnerships inside and beyond the hospital
Research potential interventions, such as successful programs run by other health systems
Consider funding implications and what sources are available for funding (i.e. local government and community agencies)
Educate patients, providers, and the community about the initiative
Assess and modify initiative to improve housing options, patient eligibility, and outcomes

Population health management and value-based reimbursement success hinge on reducing healthcare costs not only when a patient is in the exam room, but also when they are beyond the walls of the practice or hospital. Therefore, understanding where a patient lives, their income, education level, job status, and other social determinants of health (SDOH) is critical as providers aim to reduce healthcare costs and unnecessary utilization.

Socioeconomic factors are responsible for approximately 40 percent of a patient’s health, while just 20 percent were tied to care access and quality of care, the American Hospital Association (AHA) recently reported.

Despite the impact SDOH has on a patient’s outcomes and costs, many providers are not equipped to address housing, economic stability, education, food security, and other social determinants.

Providers in a recent Leavitt Partners survey cited insufficient appointment time and lack of compensation as top barriers to addressing SDOHs. Fee-for-service payments do not reimburse providers for extending care beyond the practice’s or hospital’s walls and even some alternative payment models have yet to branch out into integrating medical, social, and behavioral services.

This approach requires a collaborative approach and unique leadership skill to develop, maintain and develop resources, both financial and human to attain.

It is a brave new world with enormous opportunities as organizations and providers realize an ability to influence SDOH as never before.

In the past providers have recognized this aspect of patient care, with little resources to affect the major SOH affecting patient care as well as prevention

Patients can also contribute to this concept by communicating these needs and fully encompass a patient-centered health system.


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