It has become clear that social factors drive the majority of health outcomes. As a result, we’ve seen a spike in new programs across the country that focus specifically on improving social care. Government and private entities are investing billions of dollars into these programs, with the goal of improving health outcomes and reducing healthcare costs.
SDoH programs have the potential to evolve the healthcare landscape by integrating the social needs of vulnerable patients into medical care, but what should stakeholders consider before launching such programs? And how can providers, payers, and community-based organizations (CBOs) work together to avoid SDoH program failures? We offer some recommendations below.
Avoid short-term programs for long-term, complex social issues
SDoH programs are typically pilot programs that are developed quickly in response to a specifically identified problem. While pilot programs can be important first steps in testing strategies for addressing social needs, there are inherent structural and financial challenges, including short timelines and inflexible budgets.
Pilot programs are monitored for a set period of time, and often their short timelines can make it hard to demonstrate significant outcomes. As a result, stakeholders are left deciding whether the program has been a success, based on limited information, or how to scale it for a larger set of participants.
The limited focus of a pilot program may be at odds with the complex social needs of vulnerable populations. For example, food-insecure individuals are often financially burdened and may not have the proper utilities or home equipment needed to cook healthy meals, so a home-delivered meal may not be as beneficial without food education support. The same can be said for low-income mothers who lack access to child care. You may provide them with free transportation to prenatal appointments, but find that they still skip them.
If a program does not acknowledge the nuanced realities of its participants, many of whom are facing complex social needs, you may encounter resistance from participants or underutilization, resulting in incomplete data and undesirable outcomes. This is often the challenge with SDoH programs, many of which target one issue and fail to acknowledge others.
Secure the appropriate technology to track program outcomes
In the June 2020 issue of The Milbank Quarterly, experts published a systematic review and meta-analysis of 38 SDoH experiments, finding “evidence of health benefits associated with investments in early life, income support, and health insurance interventions.” But they also found that many of the studies were “underpowered to detect health effects” and had moderate-to-high risk of bias.
“Future social policy experiments should be better designed to measure the association between interventions and health outcomes,” the researchers concluded.
SDoH programs are often implemented in direct response to clearly-identified needs, but how well is the data tracked? If you don’t have systems in place to properly assess the intervention, then you won’t be able to identify success, gaps in care, or opportunities for improvement. You need interoperable technology that allows for tracking and analyzing data across diverse systems of care. This is critical for being able to observe the program and determine whether it has the potential to yield successful long-term results.
Standardize the language and process and develop clearly identified goals
Recently, the Healthcare Information and Management Systems Society (HIMSS) asked its members to identify the biggest issues preventing the integration of SDoH into healthcare.
“The most pressing obstacle to integrating SDOH is the lack of standardization—of screening questions, tools and even what factors count as SDOH,” responded Paul Matthews, a HHSMI committee member and chief technology officer at OCHIN, Inc. “Before we change workflows, culture, or technology, we must agree on what we’re trying to accomplish and move forward collaboratively.”
When language is not agreed upon and measurements are not standardized, it’s hard to develop programs that meaningfully address SDoH. Health plans and systems, for instance, use different languages, and have different priorities, but often align on the same goal: providing higher quality care to patients. To build a successful program between the two partners, there needs to be a strong line of communication and mutually agreed upon systems and processes that enable better care coordination, delivery, and reporting.
The best programs will involve clearly-defined systems and workflows and means of measuring. This makes it possible to track the success of the program as it is running and will inform decisions about the future of the program and will help the facilitators decide whether to extend or renew it, scale it, or redesign it.
Ensuring the staying power of SDoH programs
Many SDoH programs have great intentions, but fail for unexpected reasons. One program providing a one-time complimentary ride to healthcare appointments did nothing to reduce the 36 percent no-show rate among patients at the University of Pennsylvania Health System clinics. A subsequent study found that patients preferred their existing transportation method or were saving the one-time ride for a “more important medical appointment.”
"We are probably at a peak of inflated expectations, and it is incumbent on us to find the innovations that really work," Dr. Laura Gottlieb, director of the UCSF Social Interventions Research and Evaluation Network, told NPR.
A lack of funding can prevent program evolution and success. An intervention may be working, for instance, but not well enough to justify its extension, thereby halting it before it has achieved a strong return on investment—or the finances are simply unavailable, creating a finite dead-end, which hurts not just the people it’s serving, but kills the infrastructure, systems, and processes that could have made a true impact.
To avoid program failure and make SDoH programs sustainable, stakeholders need to prioritize the following:
- Data-sharing capabilities
- Infrastructure, supporting system alignment, and coordination tracking
- Customizable features that are built for the population in mind
- Standardized language and tools
- Measurable goals
- Clearly-defined SDoH terms and language
- Additional funding that matches the nuanced complex nature of social needs
- The potential for program extensions, adjustments, or scalability
As the healthcare industry shifts toward whole-person care, SDoH programs are going to become a necessity. But in order to prevent their failure, key stakeholders need to be aware of common pitfalls and set up the right systems and processes to ensure potential success, now and in the future.