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Successful Interventions, Positive Outcomes: Understanding the Impact of Social Determinants of Health
January 30, 2018

Successful Interventions, Positive Outcomes: Understanding the Impact of Social Determinants of Health

Donald Casey and Tamara Cull
Although it’s difficult to generalize the impact of social determinants of health, addressing them is fundamental to improving overall healthcare quality for member populations.
This article was co-written by Donald Casey Jr, MD, MPH, MBA, chief of Clinical Affairs for Medecision, and Tamara Cull, DHA, vice president of Market Development for Medecision.

According to the newly released National Healthcare Quality and Disparities Report, from the Agency for Healthcare Research and Quality, disparities for the poor and uninsured populations make quite a statement. More than half of measures show poor and low-income households have worse care than high-income households, and two-thirds of measures show uninsured people had worse care than privately insured people.

Perhaps less well documented is the causal link between healthcare disparities and social determinants of health. Social determinants of health are commonly defined as “the conditions in which people are born, grow, live, work and age,” and there are clear examples that social determinants, such as access to food, housing and transportation, can intensify healthcare disparities.

For instance:
  • It is tough to follow the “healthy” diet providers often recommend if you lack access to affordable fresh fruits and vegetables.
  • If you’re living near poverty, it’s difficult to avoid the older, more allergen-prone housing situations that often exacerbate conditions such as asthma.
  • Without affordable, accessible transportation to get food and medicines and to attend doctors’ visits, it’s not easy for anyone to maintain health.

Managing social determinants of health is especially important for beneficiaries of government healthcare programs, because they automatically meet the standards for higher-risk disparities. Medicare beneficiaries must be 65 years or older and/or disabled; Medicaid beneficiaries must be living in poverty. Dual-eligible member populations are among those at highest risk because they meet the criteria for both coverages.

Plan of Action
Although it’s difficult to generalize the impact of social determinants of health, addressing them is fundamental to improving overall healthcare quality for member populations. Organizations such as the National Quality Forum (NQF) are working to develop evidence-based approaches to identify and tackle the influence of social determinants on health outcomes.  

In the meantime, health plans can also start to eat this proverbial elephant one bite at a time.

First, health plans have to recognize that a collaborative approach is absolutely essential to success. No one organization can manage social determinants of health and population health holistically. Rather, health plans and health systems must develop a community accountability model and build coalitions with their community partners.



 
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