Patient-first medicine and social determinants of health

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Apr 02, 2019

If patient-centered or patient-first medicine is the new paradigm toward wellness, prevention and improved outcomes - and I strongly believe it is – then how do we really get there?


The pressures include keeping providers at the top of their license while still developing a more holistic relationship with patients that can expand into team-based case management. And patients with chronic conditions may have several providers prescribing care.


The nexus point is gauging patient willingness – and ability – to comply with “doctor’s orders” to a level where case management meets self-management, and to a level where case management rises beyond decreasing readmissions or ED visits.

Social determinants of health are are showing us just how unique each patient’s story is outside of the hospital or the office visit.


Part of the answer is for health systems to understand the community services available and make solid connections with those agencies. That’s an aspect of case management systems often struggle with in a competitive environment. Hospitals, for example, are dutifully posting Community Health Assessments, but this shouldn’t be done in isolation or approached as a checklist process.

Social determinants as actionable data

It’s become widely accepted that episodic healthcare visits have less to do with overall health and wellness then behavior, genetics and socioeconomics. As far back as 2007, a New England Journal of Medicine article put the impact of direct healthcare at around 12 percent.1


I certainly believe that social determinants of health data needs to be factored into analytics and risk, but I fear again a checklist approach that will expand patient data, but the question is what do you do with that data? And how do you factor that data into wider population health management?


I wonder about this as vendors develop these data platforms and organizations such as the American Academy of Family Physicians and CMS, both in 2018, produced detailed SDoH screening tools. These is all good steps, but then how do we make the data actionable?

Acitng on SDoH data

In terms of population health management, can we use the data to find common SDoH issues that impact many patients, and find best practices to counter? One example is data from HHS’ Agency for Health Research and Quality, which found as far back as 2013 that malnutrition is a factor in 12 percent of non-maternal, non-neonatal hospital stays, accounting for $42 billion in annual healthcare spending. Is it avoidable, and how can a primary care team bridge community services to avoid these hospitalizations and costs?


A Chicago-based ACO much more recently began screening high-risk patients for malnutrition, and offering post-discharge follow ups such as community referrals and nutrition coupons. The ACO reports savings of more than $3,800 per patient.

But can acting on SDoH data really become a part of universal workflows and even be a factor in healthcare business models?


Medicare Advantage plans, beginning in 2020, are developing some inroads by way of reimbursement fees for transportation, food and levels of in-home support for chronically ill patients. That’s a big step, in line with last year’s policy goals statement by HHS that broad SDoH payment models are being looked at.


These points of tangibility can take social determinants out of the abstract as just another data point and advance case management to the community level, and at the same time hopefully derail the notion that SDoH only impacts Medicaid-level or poor patients. We all have habits and markers.


What’s even more encouraging big picture is a January, 2019 report in the peer journal Academic Medicine that published a consensus call to build clinical approaches to social determinants into medical school curriculums.

Thoughtful but impactful steps can mean a lot to patients and providers struggling to find common ground.


1 Schroeder, M.D., Steven A., We Can Do Better – Improving the Health of American People. NEJM, 2007, Sept. 20: 357;12 1221-1228.

About the author

Niki Buchanan

Niki Buchanan, 
General Manager & Business Leader, Philips

Niki Buchanan is General Manager & Business Leader for Philips PHM. A dynamic and versatile healthcare executive, Niki uses her distinctive customer satisfaction and product optimization methodology to lead improvements across the Health IT spectrum.

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