For more than a decade, research has shown that investing in Social Determinants of Health (SDoH) positively impacts health outcomes, health care costs, and quality of care. Estimates are that 60-90 percent of health outcomes are driven by SDoH factors that include housing, employment, transportation, food stability, health care, crime, poverty, etc. In our August article, Prioritizing Social Determinants During a Pandemic, we reviewed these social drivers and the evidence of their impact on population health. However, the literature suggests that many payers, providers, and health systems do not prioritize SDoH as a critical factor in budgeting and planning. Why the disconnect?
Industry experts have shared that other essential projects and budget initiatives often compete for the same investment dollars. Additionally, it can be challenging to quantify the Return on Investment (ROI) for social interventions, leaving physicians and health executives unsure of how to make a solid case for funding SDoH initiatives.
Still, as the industry transitions to a value-based model, many believe the need for an innovative new framework exists – one in which funds are regularly and strategically committed to addressing some of the most predictable precursors to poor health and high health care costs. Several programs across the nation have already seen impressive results from investments in social determinants; a few are cited below.
Locally, the Delaware Community Foundation, the University of Delaware Partnership for Healthy Communities, and Delaware Department of Health and Social Services launched Healthy Communities Delaware (HCD) to accelerate progress on “community-driven priorities around the social determinants of health.”
The State of Delaware is one investor in the communities HCD is collaborating with, and the initiative aims to bring public and private investors to the table. Complex problems require multi-faceted solutions as well as significant, long-term investment across sectors. Poor health outcomes have not been created by one problem, nor will they be improved by one solution. Investments through Healthy Communities Delaware include housing and food-security work on the Eastside of Wilmington, and resource navigation and civic engagement for Latinos in New Castle and Sussex Counties. None of the challenges in these areas can be solved by single sectors, agencies or by investments over a 1-3-year funding timeframe.
We can make a larger impact by working together-- aligning funding sources for evidence-based work in targeted geographic areas. We can begin with evidence-based interventions that improve both health outcomes as well as provide financial savings, such as those outlined in recommendations from the Centers from Disease Control and Prevention’s Health Impact in Five Years (HI-5):
Collaborative investments can mitigate risk, increase impact, and increase the likelihood of social and financial returns on investment.
Critical Elements to Drive Sustainability of Investment in Social Determinants of Health
Industry experts underscore the need to drive sustainable funding to support SDoH initiatives. One commonly shared strategy toward this end is to articulate ROI --- clearly define it and demonstrate how to calculate it: This is not always an easy task. However, by examining what has worked for others in the industry, some common approaches emerge:
To further aid in defining strategies to ensure the sustainability of SDoH programs, community-based organizations and their health system partners can take advantage of an ROI calculator from the Commonwealth Fund. The calculator helps stakeholders “plan sustainable financial arrangements to fund the delivery of social services to high-need, high-cost (HNHC) patients...” Such patients often consume healthcare resources due to their complex social, medical, physical, and behavioral health needs. Research shows that a holistic model combining medical care with social supports can be highly beneficial for this population.
From private payers to public health agencies, there has been a heightened focus on SDoH programs as efforts to drive value-based care advances. Strategic investments in SDoH have shown the real value and promise of the short and long-term positive impact of SDoH initiatives; such investments deliver on achieving improved population health and cost savings.
Note: This article represents a compilation of information published by others and does not constitute medical, legal, financial, or consulting advice. All information is believed to be current and accurate at the time of posting. References and links to third parties do not constitute an endorsement, sponsorship, or warranty, expressed or implied.
The ROI of Addressing Social Determinants of Health, Ohanian, A. AJM Jan 2018. Retrieved from https://www.ajmc.com/view/the-roi-of-addressing-social-determinants-of-health
Investing in Social Determinants of Health Yields High ROI, Famankinwa, J. Home Health Care News. Feb 2020. https://homehealthcarenews.com/2020/02/investing-in-social-determinants-of-health-yields-high-roi/
Addressing the social determinants of health: Capturing improved health outcomes and ROI for state Medicaid programs. Coe, E., Berg, M., Parmar, S., and Feffer, D. McKinsey Company. April 2019. Retrieved from https://healthcare.mckinsey.com/addressing-social-determinants-health-capturing-improved-health-outcomes-and-roi-state-medicaid/
Welcome to the Return on Investment (ROI) Calculator for Partnerships to Address the Social Determinants of Health. The Commonwealth Fund. Retrieved from: https://www.commonwealthfund.org/roi-calculator
Investments in social determinants will pay off, with better outcomes and value. Miliard, M. Healthcare IT News. Sept 2019. Retrieved from: https://www.healthcareitnews.com/news/investments-social-determinants-will-pay-better-outcomes-and-value
Postcard from Phoenix: Addressing SDoH in Medicare Advantage Plans. HealthEdge, Feb 2020. Retrieved from: https://www.healthedge.com/blog/addressing-social-determinants-health-medicare-advantage-plans
4 Top Successful Social Determinants of Health Programs. Kaplan, D. Managed Healthcare Executive, Jan 2020. Retrieved from: https://www.managedhealthcareexecutive.com/view/fda-updates-assays-used-in-cancer-care-get-green-light
Healthy Communities Delaware: https://healthycommunitiesde.org/
Delaware Community Foundation: https://www.delcf.org/community/hcd/