Editor’s Note: Throughout the next week, in our annual Top Ten Tech Trends package, we will share with you, our readers, stories on how we gauge the U.S. healthcare system’s forward evolution into the future.
"Social determinants of health” may be the latest popular buzz term in healthcare, yet there are leading hospitals, medical groups, and health systems, as well as accountable care organizations (ACOs) and health insurers, moving forward with efforts to identify the upstream factors that influence patients’ health. In fact, according to a recent survey by Change Healthcare and the HealthCare Executive Group (HCEG), more than 80 percent of payers are integrating social determinants of health into their member programs.
“There are a million examples every day about the importance of social determinants of health,” says Robert Fields, M.D., senior vice president and chief medical officer for population health at the New York City-based Mount Sinai Health System. “If you’re seeing a patient with diabetes, you can write a thousand prescriptions for insulin, but if they don’t have stable housing or electricity in their house, or if they have transportation issues, it’s unlikely they will be able to fill the insulin prescription, store it appropriately, or administer it appropriately.”
Healthcare leaders engaged in these efforts have found that technology is foundational to this work in the collection of social determinants data as well as for data exchange across the care continuum, workflow integration and analytics to risk stratify the highest-need individuals. From a technology solutions perspective, this remains a nascent field, many industry leaders say, and many organizations are taking a homegrown approach using their electronic health record (EHR) systems and bolt-on applications to collect and use social determinants data in various pilot projects.
“The vendors are trying to do more, but they have been slow,” Fields says. “For most organizations, they are having to piecemeal it; some of it is homegrown, but then there is actually a booming industry of vendors that fall into different categories.” At Mount Sinai, Fields is involved in efforts to address social determinants for the 400,000 covered lives in the health system’s ACO, Mount Sinai Health Partners. Previously, he had led similar efforts at Asheville, North Carolina-based Mission Health Partners, a Medicare ACO affiliated with the Mission Health healthcare system.
According to Fields, the technology solutions that are most beneficial for social determinants of health work include predictive analytics, network registries of community-based organizations, and referral platforms as part of care management solutions.
According to a report from Patchwise Labs, one particular area where vendors are playing an integral role is the technical work to enable bi-directional integrations between platforms and native EHR systems, which is critical to make otherwise siloed clinical data available to community organizations. These platforms also help to incorporate non-clinical components of patient care plans and social needs into a centralized clinical record and enable healthcare leaders to begin leveraging non-clinical data and metadata for advanced analytics work.
Healthcare organizations that are moving forward in this area are leveraging technology platforms such as NowPow, which connects both sides of the referral process—providers and community organizations—to more efficiently connect patients to social services, as well as Aunt Bertha, a social services search tool that can be used by healthcare providers and social workers. The Aunt Bertha platform is now integrated into Epic’s App Orchard via FHIR (Fast Healthcare Interoperability Resources). Another vendor in this space is San Antonio, Texas-based TavHealth, which offers a cloud-based collaboration platform to connect healthcare providers, payers and community organizations.
There are also care coordination solutions, such as Eccovia Solutions, that help to bridge the gap between primary care and community services by sharing patient information. Eccovia, based in Salt Lake City, focuses on “whole person care” by incorporating social determinants data and is used by state Medicaid agencies, ACOs and Medicaid Waiver programs. Some hospitals and health plans also leverage Pieces Technologies’ case management platform that aggregates patients’ clinical and social history.
Looking at the social determinants of health technology solutions market, Bradley Hunter, research director at Orem, Utah-based KLAS Research, says population health vendors are working to add social determinants functionalities as well. “Most vendors have providers who are talking about including social determinants of health in their data set, and that goes from the EHR vendors, the Epics, Cerners and athenahealths of the world, to the best-of-breed vendors, such as Arcadia and Health Catalyst. There’s definitely a lot of interest in it, but I don’t hear a lot about it in practice. As far as organizations actually bringing in all that data right now, I think it’s very sparse at this point.”
Currently, few healthcare organizations are investing in social determinants of health technology, according to a recent Patchwise Labs report. Market adoption of commercial tools for screening and referrals is currently under 4 percent, representing an estimated investment of $88 to $92 million.
However, as the shift to value-based care requires health systems to address the factors impacting health outcomes, this technology market is expected to grow quickly, with adoption of social innovation technology for healthcare poised to triple over the next five years, according to the report.
By 2023, 12 to 15 percent of health systems and managed care organizations (MCOs) will have invested in these tools, the report states. Adoption is expected to triple in five years’ time, driven by a growing business case for standardization around data capture, communication, and analytics, as well as key policy and market trends specific to social determinants of health, says Naveen Rao, founder and managing partner of Patchwise Labs.
Providers Making Early Progress with SDoH Screening Tools
Many leading health systems and hospitals are pushing forward with efforts with a focus on either building or investing in tools for social needs screening and referrals. Screening tools are often the first step to help identify social needs such as food insecurity, housing, transportation, education, exposure to crime, literacy, socioeconomic conditions, social support and access to medical services.
One of the many challenges, however, is that there are no standardized tools for collecting social determinants data and each organization has its own unique approach.
The Boston-based Partners Healthcare is one organization on the forefront of these efforts. As a participant in the Mass Health (Medicaid) ACO, Partners Healthcare is required to screen Medicaid ACO patients for social determinants factors and has integrated that process into its primary care practices. Once patients complete the questionnaires, the data is uploaded into the patient’s medical record and positive screens are flagged for the physician, who can then put in a referral to the appropriate community resource specialist or community health worker, Rose Kakoza, M.D., assistant medical director for Medicaid for the Center of Population Health at Partners Healthcare, explains.
Rose Kakoza, M.D.
“As far as IT, there was a lot of work to build this platform in Epic, and, for patients that screen positive, we’re able to link the positive screens with codes in Epic for that encounter. We partnered with Epic to figure out how to map the screening results to the appropriate ICD-10 codes,” she says. “This IT platform is allowing us to set up the infrastructure that we need to better capture what the needs are and the complexity of the needs and then better resource our practices to best meet those needs on the ground.”
At the University of Arkansas Medical Sciences (UAMS) Medical Center in Little Rock, clinicians in primary care offices and clinics are prompted by their EHR to ask patients questions about their personal life regarding their housing situation, eating habits and social isolation. Stephen Mette, M.D., the medical center’s chief clinical officer, says clinical and IT leaders began an effort about two years ago to embed these questions in the EHR. “We are now rolling this out to all providers, including the specialists,” Mette says.
The Danville, Pa.-based Geisinger Health System has taken an innovative approach with an IT- and data analytics-driven Fresh Food Farmacy initiative to address food insecurity and to improve patients’ diabetes management. The program leverages the health system’s EHR functionalities and data analytics dashboards to track patients’ progress. Project leaders have seen significant improvements in clinical outcomes for patients enrolled in the Food Farmacy program, to date.
Mount Sinai Health Partners has partnered with Lumeris, a St. Louis-based health plan and managed services vendor, to use its analytics platform to identify patients’ social needs and then risk stratify patients.
“Lumeris leverages publicly available data, such as census data, and also purchases social determinants data, like credit agency data, and then combines that with claims data, and the platform takes tens of thousands of factors and runs it through artificial intelligence (AI) and machine learning to come up with predictive modeling” for patients at risk of hospital admission, Fields says.
Many healthcare leaders say better data and more robust local partnerships will enable scalability and accountability in social determinants of health programs. Moving forward, providers also will need robust technology solutions that focus on workflow integration, bi-directional data exchange and analytics, as well as tools that can help digitally close the loop on community resource referrals.