How HCOs are addressing SDoH in populations with chronic conditions
Last Friday was World Hypertension Day. This chronic condition—also known as high blood pressure—affects more than 75 million people in the United States, but only 54 percent of people who have hypertension say they have their condition under control. In 2014, hypertension was the primary or contributing cause of death for more than 410,000 Americans—that’s 1,000 people per day who are fatally affected by hypertension. In addition to contributing to poor health outcomes, hypertension also costs $48.6 billion to treat each year.
Studies show that the social determinants of health (SDoH) can have a significant impact on the risk of hypertension, especially for people who have prehypertension or diabetes. By addressing SDoH, specifically food insecurity, in populations who have or are at risk for hypertension, healthcare organizations (HCOs) can improve health outcomes and reduce the costs associated with care.
Better Food for Better Health Outcomes
Research has found that addressing SDoH, food insecurity in particular, can help patients manage or prevent hypertension. A 2010 study found that food insecurity is associated with cardiovascular risks. The study examined the association between food insecurity and clinical evidence of diet-sensitive chronic diseases, including hypertension, hyperlipidemia, and diabetes. Researchers found that among non-elderly adults with household incomes <200% of the FPL, food insecurity was associated with hypertension and diabetes.
A recent simulation study of healthy food “prescriptions” developed for the Medicare and Medicaid programs also found that health insurance coverage to overcome food instability in beneficiaries would be cost-effective and improve health outcomes, particularly for those with hypertension, high cholesterol and diabetes.
Researchers considered two healthy food-prescription scenarios: 30% coverage of fruit and vegetable purchases; and 30% coverage of purchases of fruits, vegetables, whole grains, nuts/seeds, seafood and plant-based oils. Over a lifetime of current beneficiaries, researchers estimated the first coverage plan would prevent 1.93 million cardiovascular disease cases; while the broader coverage would prevent 3.28 million cardiovascular disease cases and 120,000 diabetes cases.
Addressing SDoH to Manage Hypertension
Healthcare organizations understand that food insecurity and the lack of education about nutrition can be significant obstacles to the successful management of chronic diseases, including hypertension. As a result, healthcare organizations and government departments are cross-collaborating with community-based and other social organizations to provide food-related services that complement clinical care.
For example, as part of the Million Hearts Initiative, the Summit County Public Health Department (SCPH) in Northeast Ohio launched a pilot project working with several family medicine practices to help reduce hypertension rates among black men. In Ohio, 38.5 percent of black patients have a diagnosis of hypertension, compared to 33.7 percent for white patients. Black men are also 49 percent more likely to die from stroke and 21 percent more likely to die from heart disease than white men.
SCPH care coordination units partnered with physicians to address SDoH for their patients with hypertension, such as offering food assistance, but also transportation, housing, counseling, dental care, utility assistance and vision and hearing needs. The department created referral forms for practices to use to streamline referrals for patients with hypertension. As a result, in just three months, the practices reporting data in the pilot project were able to increase their blood pressure control rates for their patients with hypertension from 69.7 percent to 73.4 percent. The practices also saw the percentage of patients who scheduled follow-up appointments for their blood pressure increase from 66.0 percent to 68.8 percent.
Another example is Boston Medical Center (BMC), which launched its own food pantry. Through its Preventive Food Pantry program, patients receive food “prescriptions” from their BMC primary care physician for supplemental foods for conditions such as hypertension, cancer, HIV/AIDS, diabetes, obesity, heart disease and other chronic diseases. In 2017, the Preventive Food Pantry provided food to 83,288 patients and their household members (an average of 6,941 people per month).
Key SDoH Takeaways
Food insecurity is linked to adverse health outcomes and healthcare costs, but by connecting patients with programs that address food insecurity could considerably improve health, reduce health inequities, and lower costs. However, developing formal relationships with nonclinical organizations can be unfamiliar for HCOs, and as a result, developing programs that combine clinical and nonclinical organizations coordinating care can be challenging.
To learn more about the challenges some HCOs face when addressing SDoH, download our white paper—Overcoming Obstacles: Challenges & Solutions for Providers Addressing SDoH. In this white paper, we explore some of the challenges providers face when addressing SDoH and high-level solutions to overcome them.