To leverage social determinants of health, start with patient matching tools

San Mateo County Health System incorporated social determinants of health into its patient records to reduce ‘epistrophic’ events among its vulnerable population.
By Tom Sullivan
10:29 AM
social determinants of health

Nestled between Cisco, Facebook, Google and other tech titans, San Mateo County Health System lies in Silicon Valley where billions are spent on biotech and big pharma, among the other VC dollars invested every month.

But as hard as it may be to imagine, 10 percent of the population in that wealthy region consists of people who are either covered by Medicaid or entirely uninsured. 

“We actually have a homeless problem. It’s hard for people to get that,” said Eric Raffin, CIO of San Mateo Health. “We have a vulnerable group. So demand is on the rise to engage more actively in understanding the population we serve.”

Social determinants of health are a critical component of that understanding and not just for San Mateo Health but, indeed, for many public health departments.

“Public health across the country has been dealing with social determinants since their inception,” Raffin added. “And this is not something your traditional integrated delivery systems have been able to do.”

What private hospitals should know

Deloitte published a report in late July, “Social determinants of health: How are hospital and health systems investing and addressing social needs?” that answered its own question: 72 percent of participants do not currently have budget for all the populations they would like to target.  

What many hospitals are actually doing is screening patients for social needs, though Deloitte found even that to be frequently conducted in something of an ad-hoc manner.

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Deloitte recommended that hospital leaders embarking on SDOH programs outline common definitions and data sets, break down existing walls between departments to share all the patient data each collects, align social and clinical information in the drive toward value-based care and identify tactics for tracking cost and outcomes.

Those are internal policy and process aspects of SDOH. When it come to technology, Deloitte said hospitals should deploy innovative analytics tools to social needs data, aggregate and segment data particular to specific populations, make that data accessible to everyone involved with the patients.

“The ability to measure results from their initiatives is necessary to advance the goals of improving health outcomes and reducing costs,” Deloitte wrote.

It’s worth it, despite vague financial impact

As is nearly always the case with an investment in technology, there is a CFO or finance department knocking on IT’s door and asking what return that money will bring.

That’s often difficult to quantify in a monetary sense. But evidence is emerging to prove the power of social determinants of health. Some of it is vague but still useful, such as lower education levels being equated with higher levels of smoking and shorter length-of-life. Another is the crime index, which essentially posits that high crime areas are less likely to have a public playground and, even if they do exist, children don’t engage in physical activity because they don’t feel safe and, in turn, people living in those neighborhoods have higher levels of obesity.

Other early SDOH findings are more specific. A particularly telling stat: Social isolation increases the risk of heart disease by 29 percent and stroke by 32 percent, according to Erin Benson, director of market planning and engagement at LexisNexis Risk Solutions.

LexisNexis has a team of data scientists that look at SDOH, including economic, environmental and social factors as well as how active people are in the community. The company built socioeconomic scores that healthcare organizations can use to risk-stratify patient populations as they shift to value-based care. Benson said thus far LexisNexis has mostly been working with payers and groups rolling out wellness programs

“We are starting to see interest from providers, there’s a high amount of interest to prevent readmissions,” Benson said. “Even though people have seen the value of social determinants, there’s growing interest because of shift to value-based care and the need to bring that kind of data in and build models.”

Sophisticated analytics tools and risk scores are a necessary foundation for building successful SDOH programs, of course, but it will take more coordination on top of those.

“Addressing health-related social needs will likely require an ecosystem approach, with hospitals and health systems working with health plans, federal, state, and local governments, community organizations and local businesses, employers, and families, to implement initiatives that impact health and quality of life,” Deloitte said.

That’s where public health comes in.

Data can do ‘something powerful’

Back in California, San Mateo CIO Raffin has coined the phrase “epostrophic” to describe care that is both episodic and catastrophic in nature.

Raffin and San Mateo were looking to reduce episodes of personal health catastrophes among patients and one of the trickiest realities was that three years ago no one could tell which patients, or even how many of them, were seeking care at different facilities throughout the county.

The hospital needed a way to unify how it collected, stored, accessed and used patient data not just in traditional outpatient settings but, just as important, in behavioral health, social services for disabled children and senior citizens, adult protective services, as well as street outreach and medicine.

So Raffin and his IT shop implemented NextGate’s Enterprise Master Patient Index — and while the commonly–agreed upon nomenclature is master patient index, Raffin insists on calling it a master person index instead because, well, every patient is a person.

“It’s not shiny. The user never sees it. But it enables everything else,” Raffin said. “If you draw a picture of a rectangle, layer cake model, at the base of all the work is the master person index. That enables us to put the HIE in place and it sets the stage for us to use other features and avoid doing things four or five times over.”

With that in place San Mateo Health can now more effectively manage patients across various facilities and it has since reduced duplicate records from 6 percent down to fewer than 1 percent, Raffin said.

In addition to incorporating social determinants and patient-generated health data into medical records and, unlike most private hospitals, San Mateo is dealing with a lot of upstream information, such as education and reading level, water purity by weaving that data into its care services.

“For me, that’s huge,” Raffin said. “We have to bring all of this data together and do something powerful with it to create an understanding of something better.” 

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