The Role of Social Determinants of Health in Value-Based Care Delivery
Four Steps to connecting "upstream" SDOH conditions to "downstream" outcomes.
- When considering cost optimization and service delivery efficiency, the business and IT often focus on population health outcomes, ignoring the holistic impact of the social conditions that are at the root cause.
- Public health and healthcare leadership require a methodological approach that helps CIOs and the organization’s leadership accelerate the strategy design process that aligns ‘upstream’ social conditions with ‘downstream’ outcomes.
Our Advice
Critical Insight
- Using an industry-specific thought model has many benefits and is central to organizational priorities simultaneously focused on enabling and enhancing the triple aim toward value-based care delivery and cost optimization.
- It is critical to understanding, modeling, and communicating the operating environment and the direction of the organization, but more significantly, to enabling measurable top-line organizational outcomes and the unlocking of direct value.
Impact and Result
Main learning objectives:
- Develop awareness about the role of social determinants of health (SDOH) in value-based care delivery and how they are connected to "downstream" health outcomes.
- Learn four critical steps to connecting "upstream" SDOH conditions to "downstream" outcomes toward cost optimization and accountable care participation.
- Discover leading data sources and curated metrics that can be used in building prediction models for nowcasting, forecasting, and scenario modeling on beneficiary and overall population health.
The Role of Social Determinants of Health in Value-Based Care Delivery
Four Steps to Connecting "Upstream" SDOH Conditions to "Downstream" Outcomes
Table of Contents
Healthcare and Government Industry Practice
The Role of Social Determinants of Health in Value-Based Care Delivery
Analyst Perspective
To successfully shift from a fee-for-service model of healthcare delivery to value-based care, cost optimization must take into consideration the "upstream" social, environmental, and institutional inequities that affect "downstream" individual and population health.
Within the past decade, the social determinants of health (SDOH) have been recognized as important, if not, key indicators of health outcomes. There is growing awareness that SDOH information improves whole-person care and lowers cost, and that unmet social needs negatively impact health outcomes.
For example, food insecurity correlates with higher levels of diabetes, hypertension, and heart failure; housing instability factors into lower treatment adherence; and transportation barriers result in missed appointments, delayed care, and lower medication compliance.
This Client Advisory Deck (CAD) provides an overview of the role of SDOH as a primary approach to supporting the triple aim through value-based care delivery.
It is designed to help healthcare and government industry members – population health practitioners in government settings, health insurers, healthcare providers, among other partners and stakeholders – to understand the connection between “upstream" social, economic, and environmental conditions – the social determinants of health known as the “causes of the causes” of ill health – and their association with “downstream" health outcomes.
It offers 4 steps to connecting “upstream" SDOH conditions to “downstream" outcomes and a hyperlinked repository to leading data sources and metrics.
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Neal Rosenblatt
Principal Research Director, Public Health Info-Tech Research Group |
Social determinants of health defined
Two key perspectives: the World Health Organization (WHO) and the United StatesTwo leading organizations – the World Health Organization (WHO) and the US Department of Health and Human Services, Office of Disease Prevention and Health Promotion (ODPHP) – define the social determinants of health as: Social Determinants of Health DefinedThe non-medical factors that influence health – the conditions of daily life that have an impact on a wide range of health, functioning, and quality of life outcomes and risks. (Source: WHO, “Social Determinants of Health” and US DHHS, “Healthy People 2030 Framework”) Health Equity DefinedThe absence of unfair and avoidable or remediable differences in health among population groups defined socially, economically, demographically, or geographically. (Source: WHO, “Social Determinants of Health”) |
Examples of Social Determinants of Health
Examples of social determinants of health that drive health outcomes:
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Social determinants of health – a brief history
| In 2005, the WHO’s Commission on Social Determinants of Health was established “to support countries and global health partners in addressing the social factors leading to ill health and health inequities.” The Commission’s aim was to “draw the attention of governments and society to the social determinants of health and in creating better social conditions for health, particularly among the most vulnerable people.” The Commission’s report was delivered in 2008. It focused on three overarching recommendations:
In the US, the US Department of Health and Human Services, Office of Disease Prevention and Health Promotion (ODPHP) launched the Healthy People Initiative. Its origin was the 1979 Surgeon General’s landmark report titled “Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention.” This report spawned a series of priorities for improving the nation’s health in 10-year increments. Today, Healthy People 2030 builds on knowledge gained over the past 4 decades and has increased focus on health equity, health literacy, and social determinants of health with a new focus on health and well-being for all – a primary focus of the value-based care delivery model. One of Healthy People 2030’s 5 overarching goals is specifically related to the social determinants of health (SDOH): “Create social, physical, and economic environments that promote attaining the full potential for health and well-being for all.” In line with this goal, Healthy People 2030 features many objectives related to SDOH. These objectives highlight the importance of "upstream" factors – usually unrelated to healthcare delivery – in improving health and reducing health disparities. | Social determinants tend to be systemic, societal challenges – economic policies and systems, development agendas, social norms, social policies and political systems – that will be solved through long-term upstream investments and collaboration between government, the public sector, and private industry. The social determinants of health have an important influence on health equity – defined as the “absence of unfair and avoidable or remediable differences in health among population groups defined socially, economically, demographically, or geographically.” Examples of social determinants of health that drive health outcomes:
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The role of social determinants of health in value-based care deliveryHelping healthcare systems optimize performanceThe likely origin of the value-based care (VBC) model is the Patient-Centered Medical Home (PCMH) that was first introduced by the American Academy of Pediatrics in 1967. In 2007 – 2010, several value-based programs arose out of a bevy of seminal activity from the Institute for Healthcare Improvement’s (IHI) launch of the Triple Aim framework of 2007, the Medicare Improvements for Patients & Providers Act (MIPPA) of 2008, and the Affordable Care Act (ACA) of 2010. This activity began a shift from a fee-for-service healthcare delivery model focused on volume of services to a value-based care model – one that centers on care quality and outcomes and a team approach to care. And it is this shift that is significantly changing the way healthcare is delivered and reimbursed in the United States, and it is seen as a priority in many health systems worldwide. |
Institute for Healthcare Improvement Triple Aim FrameworkA three-pronged approach:
Achieving the Triple Aim is critical to the success of healthcare organizations that are moving toward value-based payment systems. The Triple Aim encourages healthcare leaders to use strategies, such as Accountable Care Organizations (ACOs), to improve the health of their communities beyond the hospitals and clinics that make up the healthcare system. (Source: Institute for Healthcare Improvement, “IHI Triple Aim Initiative.”) |
Leading social determinants of health frameworksLeverage leading-edge industry standards and resourcesMany countries, including the United States, Canada, United Kingdom, and Australia, recognize the importance of addressing social determinants of health as part of improving overall health and well-being. Several frameworks have been developed to help communities, health professionals, and others begin to better understand and address a variety of factors that affect health. Among the frameworks describing social determinants of health, these three – Healthy People 2030, ONC Interoperability Standards Advisory (ISA), and the BARHII Framework ‒ are the most highly specified and leading-edge.
Info-Tech InsightLeverage leading-edge industry standards and resources to build interoperable SDOH indicator sets for comparison measurement, population and beneficiary health status assessment, and cost optimization. |
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Connecting "upstream" social conditions to "downstream" health outcomes: a roadmap
| UPSTREAM | 1 Metrics & Standards |
2 Infrastructure & Architecture |
3 Data Engineering |
4 Analytics & Reporting |
DOWNSTREAM |
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Emergent Public Health PracticeCharacterized by:
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Current Public Health PracticeCharacterized by:
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Info-Tech Insight
Use location-based data to identify high-risk individuals and communities and provide highly targeted early intervention support as a member of an Accountable Care Organization (ACO).
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