Exploring the Role of Physicians in Addressing the Social Determinants of Health

May 24, 2018|2:51 p.m.| ASTHO Staff

Earlier this month, healthcare consulting firm Leavitt Partners published survey results which found that, while most physicians acknowledge the impact of social determinants of health (SDoH) on their patients, most do not believe it is their responsibility to address them.

In fact, while 66 percent of physicians surveyed believe help with transportation would benefit their patients, 69 percent do not believe doctors or insurance plans are responsible for providing that assistance. Similarly, 91 percent of physicians do not see themselves or insurers as responsible for helping patients with affordable housing, even though nearly half (45%) responded that receiving that type of assistance would help their patients. Survey participants gave a variety of reasons for this thinking, such as the existence of other available resources to meet patients’ needs, or that non-medical staff within the practice were well-positioned to carry out these tasks instead.

Responses varied depending on how long the physician had practiced medicine and the percentage of patients with Medicaid: Physicians who have been practicing for fewer than 20 years are significantly more likely to believe help with increasing income and assistance arranging transportation would benefit their patients to a great or moderate extent when compared to physicians who have been practicing for 20 years or more. Physicians with thirty percent or more of their patient population covered by Medicaid were significantly more likely than physicians with fewer Medicaid patients to believe help in affordable housing, increasing income, and arranging transportation would benefit their patients. From these results, it appears that greater exposure to serving low-income patients, increases the physicians’ desire to help address SDoH.

As health systems move to reimbursing providers for value, based on quality outcomes, rather than volume of services, physicians will be increasingly financially accountable for the outcomes related to those factors. For example, in a value-based reimbursement structure, a healthcare entity could be financially penalized for poor health outcomes, such as an increase in asthma prevalence and in poor asthma control, even though asthma prevalence was primarily being exacerbated by substandard housing conditions and stumbling blocks to obtaining medications. In such a system, regardless of the perspectives expressed in this survey, providers will not be able to avoid being held financially responsible to some extent for the consequences of unaddressed social determinants of health.

Many questions remain: How can physicians trained in medicine transition to a new way of addressing patient care? Will the move to value-based reimbursement and its relationship to addressing the social determinants ultimately spur a change in the how clinicians practice? Will clinical providers and doctors, in particular, begin to perceive non-clinical services as a core component of quality care? Might these changes increase burnout and professional dissatisfaction among providers? How can providers work within multidisciplinary teams or other professionals to address SDoH?

To help answer these questions, ASTHO has worked with the American Academy of Family Physicians (AAFP) to explore the role of family physicians in addressing health-related social needs. AAFP has identified specific opportunities for physicians to address SDoH, such as equipping physician practices to screen for and respond to identified needs, identifying specific screening tools, and suggesting workflow designs that incorporate screenings and referrals. ASTHO is also partnering with CDC to raise awareness of CMS’ Accountable Health Communities Initiative through which CMS is funding bridge organizations in 23 states to address the health-related social needs of the complex and fragile dually-eligible Medicaid beneficiaries.

In addition to these avenues, the Leavitt Partners white paper highlighted factors that may assist providers in addressing SDoH, including:

  • Shared incentives and responsibility for addressing social determinants of health beyond the clinic walls.
  • Technology that alleviates burdens on physician time.
  • Increased funding and infrastructure, such as networks of community health workers or inventories of community resources available to address SDoH.  

ASTHO’s Center for Population Health Strategies (CPHS) proposes using the framework of the three pillars of population health to ensure optimal health for all: (1) linking clinical services with social or human service providers in the community, (2) addressing health equity as critical to improve population health, and (3) utilizing data analytics/public health informatics for decisionmaking. CPHS initiatives related to each of these pillars include partnerships on CDC’s 6|18 initiative, a multisector tool for improving health equity, and partnership with the ASTHO Informatics Directors Peer Network.

While physicians are just one of multiple professions needed to support population health improvement, they are important partners for public health to engage as the health system shifts toward value-based care and integrated delivery systems. State health agencies can work with provider associations to identify and develop new policies and practices to address SDoH and serve as the chief health strategists and conveners in statewide population health transformation efforts.