Addressing Social Determinants of Health (SDOH) in Healthcare Part 2

Research studies have consistently shown that social determinants of health (SDOH) account for a significant portion, between 30% to 55%, of health outcomes. Recognizing the profound impact of SDOH on patients' physical and mental health, hospitals, health plans, and federal and state programs are now acknowledging the importance of capturing SDOH data to provide holistic care to patients.

The Joint Commission, a nonprofit organization that accredits healthcare organizations and programs, has recently taken a crucial step by updating its accreditation standards to include a new element of performance (EP) specifically focused on screening for social determinants of health. This means that healthcare organizations are now required to assess patients' social determinants of health and develop plans to address any identified needs.

Similarly, the Centers for Medicare and Medicaid Services (CMS) have also recognized the significance of addressing SDOH. In January 2021, they introduced the Community Health Access and Rural Transformation (CHART) Model, aimed at improving access to high-quality healthcare and addressing social determinants of health, particularly in rural communities. Through this model, CMS aims to support community-driven initiatives, such as providing better access to transportation, housing, and healthy food options.

By incorporating SDOH into their accreditation standards and value-based care programs, both The Joint Commission and CMS are highlighting the importance of addressing SDOH in healthcare. This will likely lead to improved patient health and reduced health disparities over time.

To adhere to The Joint Commission's six elements of performance for SDOH in the 2023 calendar year, healthcare organizations should lay out a comprehensive framework for collecting SDOH data:

• Leadership: Form an organizational committee dedicated to addressing SDOH and ensure that leadership is committed to this initiative.
• Assessment: Use appropriate screening tools to assess patients' social determinants of health. It is essential for health system leaders and informatics leads to understand available tools and regulations, including administrative claims data, electronic clinical data, standardized patient assessments, and patient-reported data and surveys.
• Identification: Identify patients with unmet social needs and prioritize those who require intervention.
• Intervention: Develop actionable plans to address the identified social determinants of health and provide necessary support and resources to patients.
• Evaluation: Regularly evaluate the effectiveness of the intervention plans and make improvements as needed.
• Communication: Ensure effective communication among all stakeholders involved in addressing SDOH, including patients, healthcare providers, and community organizations.

For CMS's voluntary reporting of SDOH in the inpatient sphere for the calendar year 2023, healthcare organizations can begin reporting voluntarily. However, starting in January 2024, reporting will be required, with a submission deadline of May 15, 2025.

CMS requires the screening of five specific SDOH domains for admitted patients in 2024:

1. Food Insecurity
2. Interpersonal Safety
3. Housing Insecurity
4. Transportation Insecurity
5. Utilities (a newer domain, which falls under a larger driver of financial insecurities)

To ensure a unified approach across various healthcare settings, including ambulatory, emergency department, inpatient, and home health, healthcare organizations should coordinate efforts in addressing SDOH.

Additionally, CMS will also introduce two inpatient quality reporting measures for SDOH in 2024.

• Screening for SDOH: This measure will assess the number of patients who were screened for the five domains of SDOH for individuals aged 18 years or older.
• Positive rate for SDOH: This measure will track the number of patients who screened positive for any of the five domains of SDOH.

In conclusion, addressing social determinants of health is becoming increasingly crucial in healthcare. With both The Joint Commission and CMS emphasizing the importance of SDOH, healthcare organizations must implement comprehensive frameworks for collecting SDOH data and developing intervention plans. By doing so, hospitals can better serve their patients holistically, leading to improved overall health outcomes and a reduction in health disparities.

Read more
Nursing Impact on Social Determinants of Health (SDOH) Part 1