Social determinants hold the potential improve care, reduce costs and enhance the lives of individuals, but so far the business and financial incentives haven't existed for putting them to widespread use. With the transition to value-based care and population health programs, however, social determinants are on the verge of becoming more mainstream.

But that will require new technologies, education and operational strategies from hospitals and the industry at large amid the broader digital transformation – as well as new thinking about what exactly counts as a social determinant of health.

"We haven't yet touched the surface on the social and emotional dominants of health," said Jitendra Barmecha, CIO at Saint Barnabas Health System, during a panel discussion at the Digital Medicine Conference in New York. "Unless we tackle all of those we have not become patient centered."

Why digital skills and health literacy should be classified as social determinants of health

For hospitals and health systems to advance patient-centered care, of course, their populations need access to broadband and digital health tools.

To that extent, digital skills should be included as a social determinant of health, according to Amy Sheon, executive director of the Urban Health Initiative at Case Western Reserve University School of Medicine

"If you don't have connectivity, you won't be able to improve income, education, employment," Sheon said. "Populations that have limited digital skills are not just going to walk to resources you make available."

Dr. Ashish Atreja, chief innovation and engagement officer at Mount Sinai, recounted a patient encounter with a woman who was unexpectedly losing weight. It turned out that she couldn't walk well and in the colder months did not go to the grocery store so she simply was not getting necessary nutrients. But she also used Uber to get to his office – so Atreja determined that he had to train her to use an app or Amazon to order groceries for delivery.

Even with broadband, smartphones, wearables and other digital health tools, however, data literacy remains a major issue.

"SDOH health literacy has the same problem as our education system: it thinks everyone learns at the same pace, and that everybody learns the same way," said Dr. Ram Raju, senior vice president at Northwell Health. "We need to revolutionize the patient education platform. It can't be like my iPhone where I have 48 apps and only use three."  

Personalized social determinants

The world is becoming hyper-personalized, whether in banking, retail, even airlines and, to a certain extent, medicine is also moving in that direction.

"In this age of personalized medicine, we need to be thinking about personalized social determinants of health," said Dr. John Mattison, chief medical information officer at Kaiser Permanente. "All the principles of personalized medicine apply to personalized SDOH."

Northwell's Raju pointed out that personalizing care means serving patients the way they want to be served because there's a difference between telling someone during an office visit to take a pink pill every Wednesday morning and letting them know on Wednesday morning that it's time to take the pink pill.

"What we still don't know is which determinant is predominant," Atreja said. "We generalize across disease and geographical locations. We need the science to create the ROI of assessing and intervening on SDOH."

Inspiring social determinants

Now is the time to solve the social determinants of health by paying for housing, transportation and putting supplemental systems in place, according to Paul Loberti, Medicaid Administrator for Medical Services at the Rhode Island Executive Office of Health & Human Services.

Baltimore City Health Department CIO Michael Fried added that there's a massive opportunity in population and public health to build apps and innovation that go beyond the physical hospital and that healthcare needs both patient-facing and institution-facing tools to accomplish that.

"Health systems can be the 800-pound gorilla that makes that happen," Case Western Reserve's Sheon said.

Indeed, making the most of social determinants will also require cross-industry collaboration and information sharing that has not happened in the past.

"Unless we inspire, catalyze and coordinate initiatives across various entities – education, law enforcement and healthcare – to take a better evidence-based approach to these problems in our communities," Kaiser's Mattison said, "we're going to keep spinning our wheels."  

Twitter: SullyHIT
Email the writer: tom.sullivan@himssmedia.com

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