Making SDOH Measures Impactful (Part 2)

by | Jun 17, 2022 | Blog

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In a previous blog post, we discussed CMS’ proposal that would add three measures to the Hospital Inpatient Quality Reporting Program for Fiscal Year 2023 to address health equity. Two of the measures focus on screening and identifying individual social needs that impact health, in an effort to better serve patients and improve outcomes. 

A key part to ensuring that these regulations are meaningful is to get feedback from clinicians. Clinicians are often the one collecting data and taking what is learned to improve a patient’s care (or direct the patient to a person or service that will help). So, we asked our Founder & CEO, Subha Airan-Javia, MD, FAMIA (who is also a practicing hospitalist) her thoughts on how to make these SDOH regulations the most impactful for patients. 

Q: Why do you think it’s important for CMS to propose these reporting measures?

A: “Having CMS make SDOH/health equity reporting a regulatory requirement ensures it gets done and is moved to the top of the priority list. Without that, it is very possible that no organization will do it otherwise because there are just too many things piled on to their plates already. One thing I would want to be careful with, or watch out for, is that the execution of this requirement is done with the true intent in mind, and not just in a way that checks a box. We want to make sure that we are getting the benefit of this data collection and reporting, which is improved outcomes and better health equity.” 

Q: What kind of SDOH data should health systems/clinicians be collecting?

A: “There are many people more well-versed in this area, and plenty of data on recommended best practices, but the top things that come to my mind are: housing insecurity, food insecurity, transportation availability, reading and health literacy level, and physical and psychological safety.  The focus should be on things that impact care the most.”

Q: How can organizations make sure the data is usable and actionable? 

A: “We need to start with problem-focused, user-centered design – both from the clinician and the patient’s perspective. What is the problem we are trying to solve and the goal of this effort? I have already seen some EHRs make questionnaires about SDOH where on one screen, separate from the clinician’s normal workflow, there is a form with 5 main SDOH questions, each with 5-7 sub questions, requiring about 30 clicks to get through the entire thing. It may be good for reporting, but ideally this information would be made available for clinicians to easily incorporate into their plans. For a diabetic patient it’s helpful for a physician to know that the patient doesn’t have access to healthy food or a pharmacy. One way to ensure this data will be most useful, is to have proper coding of the elements as SNOMED terms, so the information is standardized across EHRs and interoperable across health systems as well as community organizations. For example, having a way to identify those social determinants that affect everyone in a household, not just an individual, so you can provide house-level support to help everyone. Instead of three different people in one house getting three different food services, allowing community organizations to coordinate can help consolidate the services provided in a way that is more effective and enables providing them to more people.”

Q: How can clinicians collect data in an unbiased/non-judgemental way so that patients do not feel embarrassed and answer honestly?

A: “One way is to make clear that we ask all patients these questions, and that we are not singling certain patients out based on how they look. I would couple this with explaining that the reason we are asking these questions is that we want to do everything in our power to help provide comprehensive healthcare, and these factors impact health and wellbeing. It is also important to standardize word choice to reduce stigma, for example saying “access” instead of “insecurity”. 

Q: What resources are needed and who should be providing them?

A: “It truly takes a village. Many clinicians do not know where to start, and this is where organizations can help. For example, there are resources already available that clinicians aren’t aware of. For health systems, make sure your clinicians know what systems are already in place to help patients, as well as what is coming down the pike. For example, if a patient is struggling with access to healthy food choices, make it easy for clinicians to see food programs for specific zip codes. Additionally, make it easy for clinicians to collaborate across disciplines, across locations and across specialties to share this information to maximize collaborative care planning for patients and their caregivers.”