The social determinants of health—economic and social factors that impact health status—have received considerable attention from Health and Human Services (HHS) Secretary Alex Azar. In his November 14th speech at The Hatch Foundation for Civility and Solutions, Secretary Azar names the social determinants of health as the root cause of much of today’s healthcare spending.
Azar states, “We believe we could spend less money on healthcare—and, most important, help Americans live healthier lives—if we did a better job of aligning federal health investments with our investments in non-healthcare needs.”
As a clinical pharmacist delivering chronic care management (CCM) services, I have seen many patients whose health conditions are impacted or solely caused by social and economic factors. Ongoing medication therapies, emergency room visits, and extended hospital stays are often underpinned by factors outside of clinical care. The well-being of patients and families is thwarted, health outcomes compromised and a plethora of wasteful spending that ignores root cause and common sense. Asthma patients living in homes contaminated with mold, non-adherence to life-dependent medications due to cost, and diabetics without access to healthy food are commonplace.
Sweeping changes to healthcare delivery are expected in 2019, as the journey to a value-based healthcare economy continues. One of these changes will likely be an uptick in chronic care management services provided to Medicare patients with two or more chronic conditions. Addressing the social determinants of health is a compulsory aspect of Medicare-reimbursable CCM services—so it is reasonable to assume more patients will be adequately screened. Community resources (with paper-thin budgets) will likely be tapped for resource provision—healthy meals, transportation or funding for electricity bills. Addressing social determinants of health through CCM services is promising for Medicare patients; however, much work will need to be done to ensure adequate funding for resources.
In his November speech, Azar stated, “Just like how every patient is different in healthcare, every person has unique social service needs—and we are intent on designing models that connect them to the services they need, rather than offering a one-size-fits-all approach.”
A 2014 study by Dr. Seth Berkowitz evaluated the relationship between material need insecurities, control of diabetes mellitus and the use of healthcare resources. Berkowitz concluded, “Health care systems are increasingly accountable for health outcomes that have roots outside of clinical care. Because of this development, strategies that increase access to health care resources might reasonably be coupled with those that address social determinants of health, including material need insecurities. In particular, food insecurity and cost-related medication underuse may be promising targets for real-world management of diabetes mellitus.”
In the context of the study, addressing the social determinants of health is aligned with The Quadruple Aim: improved population health, reduced care cost, satisfied patients and satisfied providers. And Secretary Azar seems to agree: “What if we provided [sic] solutions for the whole person, including addressing housing, nutrition and other social needs? What if we gave organizations more flexibility so they could pay a beneficiary’s rent if they were in unstable housing, or make sure that a diabetic had access to, and could afford nutritious food? If that sounds like an exciting idea…I want you to stay tuned to what CMMI is up to.”
Yes, Secretary Azar, our curiosity is piqued!