Published on June 25, 2020
SDoH & The Hidden Barriers to Better Healthcare
The U.S. spends more money on healthcare than any developed nation. Yet health outcomes aren’t improving, even as spending continues to increase. What makes this so?
A neglected social safety net, having long ago fallen into disrepair, leaves broad swaths of the U.S. population underinsured, without access to healthy foods, adequate housing, and regular preventative care. This negligence has proven costly as a growing number of people need expensive medical care for health issues that could have been mitigated or altogether prevented with social interventions.
The World Health Organization defines social determinants of health (SDoH) as “The conditions in which people are born, grow, live, work, and age. These circumstances are shaped by the distribution of money, power, and resources at the global, national, and local levels. The social determinants of health are mostly responsible for health inequities — the unfair and avoidable differences in health status seen within and between countries.”
Social determinants account for 80% of a person’s health status and ignoring these factors can have disastrous consequences. One need only look at the stark lessons offered by the COVID-19 pandemic to see how the health inequities caused by SDoH have had a catastrophic impact on communities of color and, by extension, our health as a nation.
Together with these failures, falling reimbursement rates leave payers and providers between a rock and a hard place — as they’re held responsible for health outcomes determined by factors outside of their sphere of influence.
Yet, even as the industry recognizes the importance of SDoH, it’s still grappling with how to identify, assess, measure, and address them. Without a standard rubric, how can health systems and insurers compare, predict, and analyze health interventions?
Carrot Health recommends that the healthcare industry take a page from the financial industry’s playbook. Just as FICO uses financial standards to identify the default risk of potential borrowers, our industry can use SDoH to define and score health risks for individuals. Applying this approach to healthcare, Carrot’s Social Risk Grouper (SRG) uses over 5,000 variables from 80 unique data sources to assign risk to individuals based on the potential for SDoH to affect their health adversely. Not only does our taxonomy score every adult in the U.S., but it also creates a common language for comparing and contrasting people and circumstances. Our SRG score signals the cost, utilization, morbidity, and mortality risk of an individual in terms of the behavioral, economic, social, and environmental factors that impact their health.
A standardized system of measurement, like our SRG, gives healthcare organizations a tool to assess member/patient populations, create interventions, and measure the return on their investment in preventative programs. These actions — assessing and addressing social determinants, measuring results, and adjusting as needed — create a perpetual and virtuous cycle that increases returns over time, improves member health, and reduces costs.
To plan for future programming and expenditures without an accurate picture of SDoH is like taking a road trip with an outdated map. You may end up somewhere in the vicinity you intended, but you’re likely to take several wrong turns and burn more gas than necessary along the way. By contrast, investing in a GPS that gives you real-time data about detours and traffic jams and tracks your progress toward a specific destination can help you get where you need to go without wasting time or resources.
To learn more about why it’s essential to quantify SDoH and how to make the best use of dynamic health data, download the free white paper: “Dynamic Risk Stratification: Incorporating SDoH, Engagement, and Adherence Data to Predict Holistic and Risking Risk.”