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Their role in meeting patients’ social needs is likely to increase as more take on accountability for cost under payment reform.
Social needs, including food, housing, utilities, transportation, and experience with interpersonal violence, are linked to health outcomes. Identifying patients with unmet social needs is a necessary first step to addressing them, yet little is known about the prevalence of screening. A recently published JAMA study investigates the prevalence of screenings by practices and hospitals.
The study’s findings suggest that few U.S. physician practices and hospitals screen patients for all five key social needs associated with health outcomes. Practices that serve disadvantaged patients report higher screening rates. The role of physicians and hospitals in meeting patients’ social needs is likely to increase as more take on accountability for cost under payment reform. Physicians and hospitals may need additional resources to address patients’ social needs.
A cross-sectional survey analysis of responses by physician practices and hospitals to the 2017-2018 National Survey of Healthcare Organizations and Systems reveals that only about 24% of hospitals and 16% of physician practices reported screening for food insecurity, housing instability, utility needs, transportation needs, and interpersonal violence.
Among 4,976 physician practices, 2,333 responded (46.9%). Among hospitals, 757 of 1,628 (46.5%) responded. After eliminating responses because of ineligibility, 2,190 physician practices and 739 hospitals remained.
Screening for interpersonal violence was most common (56.4% of practices and 75% of hospitals), and screening for utility needs was least common (23.1% of practices and 35.5% of hospitals), the study finds.
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Federally qualified health centers and physician practices participating in bundled payments, primary care improvement models, and Medicaid accountable care organizations screened more than other hospitals, and academic medical centers screened more than other practices.
“It’s not surprising that organizations participating in payment reform are more focused on the social determinants of health. These organizations are aware that these social issues are significant contributors to our ballooning healthcare costs and, therefore, negative contributors to their bottom line,” says Mark Prather, MD, CEO and co-founder of DispatchHealth, an on-demand healthcare provider. “This (study) highlights the gap in awareness that we currently have. However, I am encouraged by some of the new rules within Medicare Advantage plans that offer payments for vendors who supply social needs solutions. It is important for us as a society to aggressively tackle what is arguably the biggest driver of morbidity and medical costs.
“The study suggests that U.S. clinicians and hospitals should increase their focus on the social determinants of health,” he says. “Social needs, including food, housing, utilities, transportation, and experience with interpersonal violence, are undeniably linked to health outcomes. In recent years, we have seen an increased interest in the provision of care in the home. In part, this is due to the ability for in-home providers to easily identify social needs that might otherwise be overlooked in the facility setting.”
DispatchHealth delivers mobile healthcare to patients in their homes, and its providers have learned to quickly identify social determinants that weren’t previously possible in a traditional healthcare setting, Prather adds. “The ability to draft a care plan in the context of a very visible social situation naturally creates a more aligned and adherent plan that, in turn, produces improved outcomes.”