Healthcare is experiencing a significant transformation largely driven by the shift from fee-for-service care to value-based care. This shift requires moving from a reactive system that reimburses for treatment of disease, to incentivizing better outcomes that can be achieved by using a proactive approach that focuses on prevention. This current focus on reactive treatments and end-of-life care is prevalent in our system, where 5% of the U.S. population generates over 50% of all health care costs. The shift to value-based care also calls for reimbursement to prioritize the quality of care with providers focusing on reducing variation and providing the best, evidence-based solutions.
However, this transition of the clinical care delivery system will not be enough to move us into a fully value-driven health system, as medical care alone accounts for less than 20% of healthcare outcomes. The remaining 80% of the factors that determine health and well-being is based on social determinants like income, education, where people live, their social network, health behaviors, and environment. Together, these factors are called Social Determinants of Health (SDoH). These factors significantly affect an individual’s probability to develop health conditions as well as their ability to manage these conditions after their diagnosis. The World Health Organization defines SDoH as, circumstances shaped by the distribution of money, power and resources at global, national and local levels. The Social Determinants of Health are a key driver of health inequities – the unfair and avoidable differences in health status seen within and between countries.
Examples of SDoH include:
• Income Level
• Educational Opportunities
• Occupation, Employment Status, Workplace Safety
• Availability of Transportation
• Access to Housing and Utility Services
• Access to Nutritious Food
• Childhood Experiences & Development
• Social Support and Community Inclusivity
• Neighborhood Conditions/Physical Environment
• Exposure to Violent Behavior
• Access to Safe Drinking Water & Clean Air
• Recreational and Leisure Opportunities
As providers move to a value-based care delivery model, they must understand the underlying social determinants that account for most patients’ health outcomes. This is especially true considering 68% of patients have at least one adverse SDoH that they must overcome to achieve optimal health.