Why Addressing the Social Determinants is Key to Improving Care and Managing Costs

When the Institute for Healthcare Improvement introduced the Triple Aim, it provided both a challenge and opportunity for healthcare networks to think outside of the box and come up with new solutions to existing problems. As part of that goal, the American Hospital Association of Trustees created a task force that was given the assignment of finding innovative ways of addressing the unique healthcare needs found among vulnerable populations living in inner-city neighborhoods or rural areas. The 29 members of the Task Force on Ensuring Access in Vulnerable Communities highlighted technological innovations, delivery methods improvements, and examples of health networks successfully addressing the social determinants of health.  

Nutrition in Healthcare 

In Toledo, Ohio, ProMedica Health Systems understands that healthy eating habits are a foundational component of enjoying a healthy life. As in many vulnerable areas, ProMedica determined that many of the conditions they were seeing that are linked to poor nutrition were often a result of their patients lacking access to affordable, nutritious food. To address the long-term issue, they created a program that takes nutrition education into the schools and teaches both students and parents foundational principles of nutrition, as well as how to shop for healthy options on a limited budget. They also created the ProMedica Food Pharmacy to alleviate immediate food concerns. A doctor can write their patient a prescription for the Food Pharmacy, and then the patient can go pick up several days worth of nutritious food for their family. By looking after the nutritional needs of their most at-risk patients, healthcare networks can improve their patient’s’ immediate lives and reduce the risk of long-term health complications.  

Proactive Care Prevents Future Problems 

Another example can be found in West Baltimore, where Ben Secours Hospital has determined that the best way to address the cost of emergency medical treatments is to reduce the need for them. In partnership with other hospitals, health networks, and community organizations, Ben Secours has spearheaded programs which are designed to support preventative health measures and improve the overall health of the community. These initiatives have included everything from increasing the number care coordinators and primary care physicians to providing grants for fitness equipment, healthy eating programs, and fitness classes.   

Lehigh Valley Health Network in Pennsylvania and Kaiser Permanente in California are two more examples of healthcare networks that have begun addressing social determinants of health as part of their goal of achieving the Triple Aim. Both networks have created their own unique screening processes to identify patients who are in frequent need of care because they lack reliable access to basic needs such as food or shelter. Once these individuals have been identified, specially trained teams assist them in accessing resources that are available to help meet their needs These programs have shown that by coordinating with the patients and all applicable health and human services providers, hospitals can improve the long-term health of their patients and lower operational costs through reducing repeat emergency department care.  

Housing is Healthcare 

Access to reliable, safe housing is often one of the most defining social determinants for a healthy life. Many of the healthcare systems so called “super-utilizers” are individuals who are experiencing homelessness. These individuals often live with chronic mental and physical health conditions and rely on hospital emergency departments as their only access to medical care. As noted above, many healthcare networks have recognized this relation between stable housing and high hospital utilization and have begun directing patients to organizations that can help. Recently, however, some hospitals have started to take the matter into their own hands.  

In 2015, with the encouragement of several healthcare associations, the IRS recognized investing in housing as a community benefit under the tax code which governs hospitals. By doing so, they opened opportunities for hospitals to directly invest in projects which provide their highest risk patients with clean, safe housing. What this investment looks like varies, with different health networks choosing the methods that best meet the needs of their communities. In Chicago, the University of Illinois Hospital & Health Sciences System has partnered with existing housing organizations to literally pay the rent for some of their most critical need patients. The Florida Hospital in Orlando has invested over one and a half million dollars into a city project to build apartments and house up to three hundred chronically homeless individuals. SBH Health Systems in New York sold part of their hospital campus to a developer as part of a project to build affordable housing. The methods were diverse, but the outcomes have been primarily positive for both the patients and the hospitals.  

It has long been known that social determinants, such as access to preventative care, nutritious food, and stable housing, can have drastic implications on an individual’s immediate and long-term health. Healthcare networks are now showing that by addressing these issues as part of a patient’s comprehensive care plan, they can improve the health of their patients and their communities while managing their overall costs.  

Blog Resources

http://www.aha.org/content/16/ensuring-access-taskforce-report.pdf 

http://www.hhnmag.com/articles/7821-housing-is-health-care 

http://www.hhnmag.com/articles/7818-why-hospitals-are-housing-the-homeless 

https://patientengagementhit.com/news/solving-homelessness-to-overcome-population-health-challenges 

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