The economic fallout related to the COVID-19 pandemic has yet to hit healthcare, but the result is likely to be an amplification of longstanding disparities within the U.S. healthcare system. Factors such as food insecurity, homelessness and access to care can affect a staggering 80% of patient outcomes.

There is no single solution, and healthcare providers now have to deal with the patient-care landscape as it exists. These social determinants of health factors now are the new reality, but advancements in data analytics and patient connectivity can help providers to identify these SDOH factors and work with patients to address disparities and produce tailored, patient-centric outcomes based on their needs.

Healthcare IT News sat down with Dr. Joe Nicholson, chief medical officer at CareAllies, to get his perspective on SDOH, analytics and patient connectivity, and how they can come together to improve patient outcomes.

Q. Healthcare has yet to experience the economic fallout related to the COVID-19 pandemic. The result may be an intensification of longstanding disparities in the healthcare system. Please discuss the fallout.

A. This is a deep and complex topic that could spur hours of discussion. However, in general, the pandemic has really exposed problems with the U.S. healthcare system in a number of ways.

In the immediate, one of the first and biggest concerns is the pent-up demand for care. Looking at the data, including our own in-house data here at CareAllies, the elective surgery percentage is still way down. There are a number of elective surgeries people have put off, and now the system needs to catch up.

More concerning – I predict that's not likely to happen until 2022, and that's a best-case scenario. There are many reasons behind this, but the main one is that nobody expected a universal pause to the flow of patient care.

This collective pause will have a long-lasting ripple effect on the industry: Patients haven't been getting preventive care, and they've been missing out on diagnoses. They've been delaying care for existing issues, and the corpus of all of this should start to come to light later this year.

I know I have been having these discussions behind the scenes for months, as have others in the industry, but now it seems many prominent doctors and experts are openly discussing that the aftermath is coming, and it's a huge problem.

Taking cancer as an example, the delay in testing means more cases of serious or late-stage cancer will be diagnosed in late 2021 or 2022 – and that will lead to more treatment, harder final days and lower survival rates. And that's all going to seriously strain the American healthcare infrastructure, not to mention bring a lot of additional mental and physical pain to a lot of people.

The second part of this all is the amplification of disparities. We have a widening gap between the "haves" and the "have-nots," and the state of SDOH is not only "worse" for lack of a better term, but now it's also uncertain.

We have patients who may live in a medical desert, or who may be facing evictions. They may not have transportation anymore – or a stable income. And that compounds the care delays, but it also complicates the ability to deliver care.

The health system at large now has to reach those people, find ways to support them in their communities, and develop new strategies that will alter the way care in this country is delivered. The people who struggled economically during this pandemic are suffering, and will continue to suffer the most when we talk about this issue of delayed care.

Q. Factors such as food insecurity, homelessness and access to care seriously impact patient outcomes. What does the healthcare provider organization C-suite, including the CIOs, need to be doing today?

A. No. 1, providers and C-suite leaders need to start where they are and do what they can in their own communities. I think that's the really important message to get across to the CIOs, CMOS, CEOs – everyone in the C-suite. They need to lead by example and do what they can to help the people in their communities.

Second, they need to adopt a robust SDOH program to address the problems exacerbated by the pandemic. This is not something they can ignore, and everyone needs to be pushing leadership to address the situation by making changes to the way they operate.

However, the key is that all of the above should already be happening. The time for talk and planning should be behind us, and providers and C-suite leaders should now be putting plans into place, transforming the way they deliver care to make sure this shift in social determinant factors is being addressed.

But sadly, I am still hearing people say "How can we start?" and I just want to yell, "You're killing me, Smalls!" They should have already started. But now that we're here, start where you are. Start small, but take the first step. And realize anything you do will need to be expanded on, but you have to start making a dent in this problem right away.

Q. You believe advancements in data analytics can help providers identify SDOH factors, work with patients to address disparities and produce tailored, patient-centric outcomes. Please explain the role of analytics here.

A. This is where robust data storage and analytics become so important. Data is what will allow for custom, patient-centric outcomes. The rub is you want multi-source data. I think what happens is, a lot of healthcare organizations will start and end with the data they have their hands on. So a payer will look at claims data, and a provider organization may turn only to their EHR.

But that's not enough. Inherently, that means the data these organizations are operating with is going to be incomplete, and that's simply insufficient when it comes to SDOH.

Over the years, numerous studies have come out that single sources of data without context for socioeconomic differences create inherent biases. One such study leveraged historical cost to determine future health status. Unfortunately, Black and Latinx populations go to the doctor less often, so they automatically had lower historical costs. But that does not predict their current or future health. The study missed the much bigger picture due to the limited data and the way the algorithm was set up.

This is where HIM leaders need to step up. Regardless of where they work, they need to use their skills and influence to provide a runway for their organizations to make an impact. My call to action would be to encourage them to get as much information and data as possible. So when you do the analysis, you can develop a much clearer picture of your patient populations.

Q. You also believe advancements with patient connectivity can help with SDOH. Where and how?

A. For starters, the trend of using apps or wearable devices continues to expand. These companies are still popping up left and right. Practically everyone has a fitness band or something similar, and there's a real opportunity to use these to gain valuable data about your patients. I would like to see more healthcare organizations seek that information out proactively.

Wearables is still a growing space that is rapidly maturing. Some of these are just a novelty and groovy and fun, and they don't provide information that will be clinically significant. But, many of the wearable trackers and associated apps can provide value.

Something as simple as a scale in a patient's house to monitor their weight and BMI through an app can be of immense value for monitoring a wide variety of conditions. So, I think a lot of consumer tech and health devices are a great way to connect with patients. But this does require some creativity and community support to truly integrate into our health system.

On the other side of the connectivity, most patient engagement and outreach programs are still using phone calls and emails. Texting is becoming more common, but that needs to be part of any program. But, what other ways can we connect with people? Let's look at places where people already communicate with others. Think Facebook Messenger or other such platforms. If there's a way to reach patients, that's something we should be considering at the very least.

The point is, technology is steadily getting into everyone's hands, and nearly every patient can be reached. You have to develop a plan that's best for them.

This is definitely a space where healthcare needs to get a lot smarter. Because you also don't want this outreach to be annoying. Something as simple as asking a patient, "At what cadence would you like to receive these messages? Weekly, monthly, etc.," will show you care about the patient and want to engage in the way they want to engage.

Q. Can provider organizations link with public services to gather patient SDOH information with "nontraditional" data sources, such as food banks, drug treatment centers, shelters and other social programs? If so, how?

A. Absolutely. I love this idea. I think every CIO should be looking at community-based organizations as part of any SDOH effort. The hard part is the "how."

Since some CBOs have a high level of sophistication, they have well-organized data sets they can share. However, that's not the case across the board. A significant number of nonprofits I have talked to or heard about are still using paper records or, if they are lucky, Excel spreadsheets. But, if you can consume the data, they can share a lot of valuable information.

However, as anyone in technology and health information management can tell you, getting that data from a spreadsheet into another system is a nightmare. You end up with a situation where most of the data is unstructured, which is the Wild West of data. But that's why we need smart people who can organize it, manage it and make use of it. And that's a heavy lift. It's hard to do. But that doesn't mean you can just ignore it.

I would love to see a national push to tie this idea of CBO data to our healthcare system to address some of our most critical health problems. This is an arena like education, where government could provide every single nonprofit CBO in the nation with software that can manage data to help with SDOH management. It's going to take some kind of national push, consensus and support to make that a reality, but I see no reason not to do it.

If it's a nonprofit that is helping people in need, they should be supplied with tools that help them to stay organized and make use of their own data in a meaningful way. This can be done while also making sure that data translates well to the larger community that is trying to help provide better care and support in this SDOH space. And that may be a pipe dream, sadly. But it's certainly a policy proposal worth getting out there.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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