Focusing on “Social Determinants of Health” to improve outcomes
Editor’s Note: John Selig is senior vice president at the Lewin Group, a national health and human services consulting firm owned by Optum. He was previously the director of the Arkansas Department of Human Services, where he led several public health, human services, and technology initiatives. A former Peace Corps volunteer, he is a frequent presenter at national forums on topics that include Medicaid, Social Determinants of Health, behavioral health, and payment reform.
John Selig, Senior Vice President, Lewin Group, sat down with Healthcare IT Connect’s Rob Waters to discuss the potential impacts of SDoH (Social Determinants of Health) data and how Medicaid is well positioned as a nationwide platform to utilize this data to better coordinate health, social programs, and community resources to improve outcomes.
Join John Selig on: Thursday, April 5 | 2:45pm – 3:45 p.m. Track 2: Measuring and Managing the Social Determinants of Health
Rob Waters. First, can you explain what is meant by Social Determinants of Health (SDOH) and why they’re important to overall health outcomes?
John Selig: Mounting evidence shows that socioeconomic factors – education level, access to nutritious food, physical safety, living environment, employment, and housing stability – affect well-being and may have a greater impact on a person’s overall health than health care services themselves. Collectively, these factors are referred to as Social Determinants of Health and they are fast becoming an area of focus, especially when it comes to how once traditional “health care” dollars are spent. The point is that health care alone can only go so far to improve health; how and where people live may be more important in determining overall health and longevity – your zip code may be more important to your overall health than access to traditional health care services.
RW. What evidence can you cite for this school of thought?
John Selig: In their book, The American Healthcare Paradox: Why Spending More is Getting us Less, Yale researchers Elizabeth H. Bradley and Lauren Taylor posit the argument – based on comparative health data from 30 countries – that investing in social services directly correlates with a country’s overall health. They point out that despite leading the world in per capita spending on traditional health care, the United States ranks near the bottom in many health outcomes; one reason why may be that the U.S. spends comparatively little on social services. Moreover, they subsequently found the same holds true with U.S. states – those states with higher “social-to-health care” spending ratios generally have better health outcomes.
RW. Are there examples from states in which SDOH are part of the overall emphasis on better health?
John Selig: There are many, but I’ll cite two: one rural and one urban example. In rural Kentucky, a diabetes coalition consults with area food banks and pantries to help them create “diabetes-friendly” food sections, and trains volunteers on healthier choices for people with diabetes – for example, green beans are preferable to corn. And my “big city” example: New York’s Medicaid program invested in supportive housing for more than 11,000 of its highest cost and highest need beneficiaries – many of whom are homeless. An evaluation by the State University of New York Research Foundation found that in the 12 months after these recipients were housed, the Medicaid program saw a 40 percent reduction in their in-patient hospital stays and a 26 percent reduction in their emergency department visits.
RW. How does this kind of investment in SDOH affect overall costs to a state?
John Selig: It may reduce costs in the long run, or allow public funds to be re-directed to other priorities. And just think of the social supports you can afford when you cut unnecessary health costs. Depending on geographic region, one emergency department visit can be equivalent to a single month’s rent; two hospitalizations could equal one year of child care; and 20 MRIs could pay the salary of a social worker for a year – all “social” expenditures that can improve overall health.
RW. Does Medicaid play a key role in focusing on SDOH for better outcomes?
John Selig: Definitely. The entire health system has a role in connecting with social programs, but Medicaid is well positioned to serve as a primary integrator. Because Medicaid operates in all 50 states, it offers a common foundation on which to build these connections. Also, as a federal and state partnership, Medicaid can be tailored to local populations while serving as the link to related social programs – and, targeted use of Medicaid funds on other social programs could eventually reduce overall Medicaid costs. Finally, Medicaid professionals have experience serving lower-income, resource-poor and often chronically ill populations with complex needs – individuals and families who would likely benefit most from a greater emphasis on social determinants to improve health.
RW. What kind of role does technology play in being able to link social programs with improved health outcomes?
John Selig: At the heart of developing an effective “culture of health” across health and other social programs is a state’s willingness to invest in technology that enables experts to see the links between those programs – and allows beneficiaries to more easily access the right supports at the right time. It’s important to identify the most pressing needs, get effective services to those who need them, and analyze and track results to know what’s working. For example, web-based, consumer-facing integrated eligibility systems allow individuals and families to simultaneously apply for Medicaid and other public health benefits, along with programs that administer food and cash assistance, child care assistance, and other supportive services. Strong data systems and analytics also provide states with capabilities to measure improvements and success.
RW. Any final thought on the benefits of focusing on SDOH to improve health?
John Selig: Health care and social services systems need each other – to serve their communities as fully as possible, to contain costs, and to improve health outcomes. We have a nationwide health care platform – Medicaid – on which states could build collaboration between agencies that provide traditional “health” services and those that offer other social services. And we have the technology and analytical capabilities to link, monitor, and assess programs and outcomes.
Focusing on Social Determinants of Health is still a relatively new field, and work still needs to be done to explore which “social investments” will deliver the highest returns. But it’s clear that investing in programs beyond traditional health care holds great promise to improve near and long-term health outcomes across the board and across the country.