Addressing Social Determinants of Health During COVID-19 and Beyond: Leveraging Collaboration and Partnerships
Editor’s note: Shaifali Ray, MHA, Vizient Senior Networks Director, also contributed to this post, which was originally published on Sg2’s parent company Vizient Inc’s blog.
As a health care professional, you’ve no doubt seen firsthand the significant effects of COVID-19 on our country’s most vulnerable populations. The disproportionate impact of who gets the virus and its economic impact serve as a bellwether of change for hospitals’ and health systems’ growing role in addressing social determinants of health.
During the initial COVID surge, hospitals and other stakeholders partnered with communities to help flatten the curve, especially among the most vulnerable populations. As the nation has cycled through more surges, we have watched hospitals find their fit and leverage data that matters to continue these efforts and expand their work with greater numbers of stakeholders and different types of programs that address specific needs and have longstanding impact on communities.
Partnerships strengthen impact
When the pandemic hit, a health system in the South Atlantic region partnered with its local health department and community organizations serving the Latinx population to address together develop information for a variety of Spanish dialects and literacy levels that explained the importance hand washing and wearing a mask. After a high number of construction workers tested positive for COVID-19, the same health system partnered with its chamber of commerce to educate area businesses about federal workplace guidance and strategies to together create information that businesses could use to educate employees about how to reduce the transmission of the virus.
In the South Central region of the United States, an academic medical center collaborated with local nursing homes and short-term rehabilitation centers to set up dedicated units to care for asymptomatic or mildly symptomatic patients after an extended COVID illness in the hospital. The program provided care for the at-risk population while easing pressure on the hospitals by freeing up beds for both COVID and non-COVID acute patients.
Finally, a large health system and health plan contributed funds to support contact tracing in its home state. The program included a partnership with a local organization that assisted with the hiring and training of 500 full-time contract tracers. The roles were filled predominantly by individuals from communities of color that had been hardest hit by COVID. In addition to the immediate employment, the individuals also received job training and skills to guide them on career paths after the initiative ends.
When looking for opportunities for projects and partnerships, many health systems begin this work with what they know best: a clinical approach, addressing the downstream impact of community conditions on the individual’s health, which often serves as a precursor to avoidable health care utilization. If you look within your own organization, you may notice consistent, high volumes of return visits in the emergency department among one of your patient populations. For example, a medical center that was home to one of the nation’s highest homelessness rates per capita, reduced ED use by 75% and hospitalized days by 33% of its often homeless “super utilizers.” Using 16 patient care navigators, patients were connected to primary care providers as well as services to address their most vulnerable social needs, including housing and food insecurity.
Organizations may also act as convenors, aligning projects and organizations to intervene with patients before arriving for care. These initiatives may still tackle manifestations of social determinants of health, but they also start to address the social, environmental and behavioral needs of individuals beyond the medical setting. These efforts require data collection and exchange; digital platforms for screening, case management and follow-up along; and closed-loop referrals that extend beyond providers to include social services. An example is the use of a platform (off the shelf or custom built) that includes an EHR-embeddable screening tool, closed-loop referrals, and algorithms that generate tailored “prescriptions” for nonmedical resources from a robust database of community providers.
Other organizations are able to leverage their roles as community anchors by participating in full-scale efforts to improve underlying social and economic conditions that impact community health. These longer-term efforts require greater investments of dollars, resources and time as well as collaboration with community-based organizations, local government, community residents and more. Leverage the insights from your community health needs assessment to identify a significant health need where you can make focused improvement.
One health system utilized the findings from its community health needs assessment to develop a multi-pronged plan that included clinical care and economic development strategies for an area neighborhood. Key initiatives focused on hiring and developing career pathways for neighborhood residents, using local contractors to build facilities, sourcing select services from area vendors, investing in community economic development projects and launching a volunteer program to engage its employees.
As hospitals and their employees focus on and do this type of work, they find it is professionally and personally rewarding to help individuals meet their basic human and health needs, but it is not easy work. And in our experience, you might experience some internal reservations from others as you move forward. Anticipate this and be prepared to address the concerns about bandwidth and return on investment (ROI). There are a few strategies you can consider.
The first is to be prepared to demonstrate some quick wins but, as you’re doing that, think about it in terms of setting the stage for long-term wins. Long-term work is not going to look like a single solution; it will very likely be a patchwork of multiple solutions.
You also can reimagine and redefine what the ROI looks like. One way to do that is to look beyond traditional ROI metrics. When it comes to programs that are addressing clinical manifestations, look at things like adherence to care regimens, compliance rates with taking medication, emergency department utilization and length of stay in the inpatient setting.
Finally, when it comes to programs that focus on aligning social needs or data with stakeholders, look at metrics. Examples include positive screening rates where you’re screening for specific social determinants of health needs and closed-loop referral rates where you’re making the connection to an organization and getting patient utilization information back.
Social determinants of health have captured national attention during the COVID-19 pandemic. As the pandemic continues to evolve, you can expect continued pressure for health systems to address social determinant of health needs in their communities. We encourage you to seize this moment to galvanize support and resources to define and optimize your role in addressing these issues.