Health is not just defined by our lifestyle choices; it is also influenced by other factors. These factors can include things such as socio-economic status, education, access to healthy food, safe housing, social support networks, and exposure to environmental toxins. These factors are called Social Determinants of Health (SDoH). Social determinants of health are known to have a significant impact on an individual’s health outcomes, with those living in poverty or with limited access to resources experiencing higher rates of chronic disease, disability, and premature death.

Understanding Social Determinants

Social determinants are described as “the conditions under which people are born, develop, work, live, and age, as well as the broader set of forces and systems shaping the conditions of daily life”. They may be in charge of up to 90% of an individual’s long-term health and outcomes.

Social determinants are the non-medical, both beneficial and detrimental elements that affect health risks and outcomes. Patients may have a harder time getting the care and resources they need to improve their health and wellness when SDoH contributes to health disparities.

Obesity, diabetes, asthma, and heart disease are all extremely tightly correlated with the environments, cultures, and habits that surround people. A complicated web of issues, including food insecurity, a lack of adequate housing or transportation, low educational attainment, the threat of interpersonal violence, and social isolation, can lead to declining health, restricted functionality, and excessively high spending.

Patients in remote areas are more likely to experience physician shortages, a lack of well-paying jobs with comprehensive insurance benefits, and challenges getting access to specialty care. Non-metropolitan locations have greater rates of suicide, heart disease, respiratory disease, and stroke, and rural areas are particularly hard struck by public health crises like the opioid crisis.

Addressing social determinants of health requires a comprehensive approach that considers the many factors that contribute to health outcomes, including policies and practices that impact living and working conditions, access to healthcare, and social support networks.

Chronic Care Management Solutions

Healthcare organizations are therefore under pressure to connect with patients outside of the hospital campus, in their communities, at their places of employment, in local grocery stores, and at their places of education. Those who are fully involved and prepared to put in the work necessary to enhance their health and wellness have the most outcomes.

Fortunately, Chronic care management (CCM) solutions have emerged as a powerful tool for addressing social determinants and improving health outcomes for individuals with chronic conditions. It is a patient-centric approach to healthcare that focuses on providing comprehensive, coordinated care that takes into account the many factors that contribute to an individual’s health and well-being.

 Chronic care management offers a special chance to manage the provision of care for chronic illnesses in a highly practical way. Healthcare providers can assist patients in identifying the precise requirements for success in their chronic care management program because chronic care case management is high touch and offers several opportunities for patient contacts. This is through the use of technology, such as remote patient monitoring (RPM) devices and patient portals, to help providers stay connected with their patients outside of the clinic. CCM uses a team-based approach to care, with providers, like social workers, care coordinators, and other specialists, working together to address the many factors that impact a patient’s health.

Chronic care management systems are specially created to assist patients in getting the support and services they require to successfully navigate social determinants of health-related difficulties. A chronic care management program that actively involves patients, asks the right questions, and pursues creative problem solving will go a long way in helping our patients live longer, healthier lives regardless of any chronic disease or SDoH challenge they may encounter. Healthcare providers might not be able to solve all patient problems, but they can help them live longer, healthier lives. Organizations that offer CCM must ensure that the chronic care management tools and services that help engage patients are easily accessible. Moreover, companies can effectively utilize chronic care management when they provide remote and telehealth choices for receiving CCM services, lowering obstacles including transportation access, cost, and wait times.

Combine CCM with other care management services such as remote patient monitoring (RPM) and behavioral health integration (BH) as part of a larger comprehensive care management program helps patients suffering from social determinant hurdles. Think about the advantages for patients in remote areas of integrating RPM in such a program.

Conclusion

Chronic Care Management systems have helped overcome these social determinants, making a significant difference for individuals, groups, and healthcare system as a whole. They help provide care management services to patients in order to better meet them where they are and assist them in overcoming SDoH barriers in order to help them reach the best degree of health and wellness possible.