A verification of reality on SDOH: challenges that we cannot ignore

Recently, I had the privilege of chairing the Virtual Rise Broudrock of Healthcare Social Determinants of Health (SDOH) event to attend their SDOH national conference in person. SDOH has been a hot topic in health care in recent years, and for a good reason. The data is clear: a very low percentage of health results is linked to direct health care activities. The non -medical factors, the conditions under which people are born, develop, live and work, most often, an impact on the results for the health that the clinical care they receive.

After being connected with SDOH experts, including health plan leaders, community organizations (CBO), suppliers and people with lived experiences, some common themes have emerged who deserve a more in -depth reflection:

It is not always non -compliance – it is inaccessibility

We have to withdraw the term “non -compliant” for good. Discovering the deep cause of these shortcomings in care often shows a maze of barriers, rather than a lack of interest in engaging in the care they need.

People don’t want to live with chronic diseases or cancer. However, for many, the reality of going to a doctor to get a preventive screening or vaccination means that they lack work. The missing work, in addition to the lost salary, means having to find a caregiver for your child or an elderly spouse and to ensure transport. Their health plan can offer resources to help, such as a free journey to the visit of a doctor, but they do not know that it exists because access to their advantages is complex and frustrating, two children, and the journey allows them to take a single additional person. So when they do not leave, they are labeled as “non -compliant”.

Rather than focusing on labels, we need to use the available data to identify the deep causes behind the care gaps, such as missed appointments, and use this information to shape the programs to eliminate root barriers. An example that was impressed to me was the opening of a community center which not only provides transportation but also allows more than two passengers while offering free childcare services during the appointments. Rides also include tablet for the patient to access the resources of the health plan during their trip. The obstacles are removed and the results of community health are improving.

CMS makes us difficult to collect data we need to approach SDOH

We have heard several times on these two events that the challenge of collecting SDOH data, such as Z codes, is that the centers for Medicare & Medicaid Services (CMS) do not give us enough space to enter the complaint form. Something as simple as the number of boxes on a form should not be the barrier providers must be confronted when they try to better understand and serve their patients.

Z codes allow us to understand the underlying stories and the deep causes affecting the health of a member who must be treated. Having this data and understanding, it is essential for us to advance SDOH significantly.

If we want providers and health plans to meet expectations concerning SDOH interventions, we need procedures that delete friction, not to add it.

Confidence and psychological security are the foundation to which you build the commitment of the members

It is not a secret for anyone that there is a lack of confidence between the health care system and its consumers resulting from a systemic set of challenges such as changes in the network, invoices that were not expected, lack of access to care and lack of customer service based on empathy. In addition to that, there is an incredible amount of fear at the moment, because we are faced with daily changes in health policies and funding as a country.

We have heard stories of speakers in Rise of People who fear that if they attend their appointment with the doctor, the ice will be called and that they will be held or expelled, so they avoid care at all costs. People in the LGBTQ + community are afraid of sharing their personal information, for fear that there are repercussions. People with disorders of consumption of substances are afraid that they will share this information or seek processing, that their jobs and personal relationships can be endangered if someone should discover it.

Health leaders must talk about how their organizations can strengthen psychological security through improved business processes, communication efforts and community support. The grievances and survey data on patients are some places to seek to identify trends in the processes or areas of the company eroding confidence with your members / patients.

Organizations that launch basic efforts by spending time in the communities they serve and asking people to share their lived experiences are able to identify community needs more quickly and develop programs to resolve them. If your organization takes advantage of community health agents, make sure that there is a mechanism for their learning and conclusions to reach key decision-makers who are responsible for the design of programs, advantages and interventions.

We know that SDOH interventions work, so let’s trust the data and finance programs

There is a large set of research on SDOH’s initiatives that have proven to be effective, for example, giving a pregnant mother at low income to healthy meals will have a positive impact on her pregnancy results. However, we continue to be invited to prove that these already proven interventions will work and should fight for funding to implement them. With the recent announcement of the CMS concerning that it does not approve of future federal counterpart funds for the designated state health programs (DSHP) and the designated state investment programs (DSIP), we are faced with another challenge to find creative means of providing programs to those who need it most.

As health plans travel through this challenge, work alongside your community organizations to find creative means of associating. Consider expanding partnerships to include the Foundation, associations and the denominational community to finance and continue the critical services for your members. Continue to engage with and defend the flexibility of policies to the local and state government.

The general consensus of those with whom I connected during these climb events was that we do not give up, but we are tired. A patient advisor and speaker Rise courageously shared that during the conference, she lost her social benefits because she failed a planned appointment on her behalf without notification. The impact on his family is unfathomable for the most part. However, she presented herself and has shared her story because she knows that so many people who experience these difficulties daily cannot defend themselves. This work is difficult and we do not have all the answers. But because we have entered this career in health care to be at the service of others, to those who need it most, we stay the course.

Photo: Gmast3r, Getty Images

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