Treat the patient and not the disease
“Better late than never.” It’s good that we are realizing how our living environment, neighborhoods, and communities; schooling; quality of water and food; our income, access to transportation and our social interactions, relationships, behavior, habits and attitudinal aspects, etc., collectively termed as the “Social Determinants of Health” or SDoH, are influencing our state of health and outcomes.
This growing awareness around SDoH, and its influence on the population health economy, is a national “call to action” for our health care system to reduce health disparities, mitigate patients’ care gaps, improve their quality of life and health outcomes, and lower care costs. Along the same lines, in an effort to reduce expenditures and improve community health outcomes, the Centers for Medicare and Medicaid Services (CMS) is testing the Accountable Health Communities Model, which is the first model to include social determinants of health, to identify and address patient health related social needs through clinical and community-based settings.
As a physician, I can imagine a scenario where a patient’s socio-behavioral, economic and attitudinal composites can drive better care decisions and patient wellbeing. Think of Julia (36/F), who comes to her primary care physician’s (PCP) office and in a follow up discussion, shares how as a single mother (with a low salary job and without any alimony) she is stressed and struggling to support herself and her child with medications, food, transportation, better housing, etc. Julia has lost around 10lb of weight and her blood sugar level has increased from past. She has started smoking cigarettes. She also missed her eye doctor and cardiology appointments in the last two months.
Julia states that she and her child have to rely more on a nearby fast food shop, as returning late from work she neither gets time to cook regularly, nor does she have enough money to afford better, healthy diet. She has to space out her daily medications and often misses refiling them. She also finds it hard to make to her doctor’s appointments, as she doesn’t have a car and has to rely on public transportation, which is a long distance from her apartment.
These all are the SDoH that are influencing hidden risk factors and worsening health conditions for Julia and other people like her, daily. These social, economic, behavioral, environment and financial factors paint the 360-degree view of a patient that every physician or care giver needs to know to render the right care service, beyond their clinical assessment.
For example, in the above situation, the PCP can now advise Julia to reduce her stress by exercising regularly, cut down on smoking and also prescribe low cost generic drugs to reduce her medication cost. Free transportation assistance can be arranged to make sure Julia doesn’t miss her doctor appointments. She can also be connected to food resources/programs like the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)) to help her feed herself and her family.
We have traditionally used claims, EMR, utilization and some health risk assessment (HRA) data to stratify patients and predict their clinical risks. But that data only provides a myopic view of a patient’s life situation and hasn’t been insightful enough to change their health trajectory by improving outcomes, quality of life and lowering care costs.
To optimally manage population health, we must look beyond the data that is traditionally captured in the system of records to obtain a wider perspective of the factors that influence our health conditions. SDoH data provides that wealth of insights to help us influence patient outreach, engagement, and improve health outcomes. Robert Fields, M.D., SVP and CMO for population health at Mount Sinai Health System rightly said “When you start to get paid on outcomes and reductions in total cost of care then it makes it financially reasonable to invest upstream into infrastructure and preventive care. Many times, that preventive care looks a lot like closing social determinants gaps to avoid the downstream cost. The economics are changing….”
As we seek to foster innovation, rethink community health and find solutions to fight the threatening opioid, marijuana, e- cigarettes epidemic, etc. we need to treat patients as individuals in a broader societal framework and not only address their present(ing) disease state. We need to take into account the social determinants of health and recognize their impact on a patient’s diseased state. These are the influencers, that if not checked early, will trigger the patient’s movement in health risk corridors from low to high, increase population health disparities and generate a broader public health challenge.
Healthcare is more social than clinical. Let’s harness the power of Social Determinants of Health and blend it with the clinical factors to create innovative healthcare solutions which can truly transform today’s “Sick Care” to a real “Health Care” world and help us all to realize the World Health Organization (WHO)’s vision of “Health for All”.
Dr. Suman De, Principal Consultant and Head, Government Healthcare Analytics Solutions, Infosys Public Services
Dr. Suman is head of government healthcare analytics for Infosys Public Services. He has extensive experience in the public healthcare sector and previously worked for the World Health Organization, UNICEF and the Indian Public Health Association.
At Infosys, Dr. Suman leads the areas of vaccine management, advanced data science and artificial intelligence-enabled population health, social determinants of health analytics, opioid management, care management, and value-based care. He is a frequent public speaker at various healthcare conferences, forums and at major universities, including the Massachusetts Institute of Technology.
Dr. Suman is based in Hartford, Connecticut. He holds a medical degree from the University of Calcutta and master’s degree in healthcare administration from the Tata Institute of Social Sciences in Mumbai, India.