How to Implement Social Determinants of Health Referral Tools

In a past life working as a nurse, Sherry Norquist, MSN, ACM, remembers going through her Rolodex when one of her patients presented with social determinants of health referral needs. She’d collaborate with her colleagues to find the best social services referral she could, give the patient a phone number, and send them on their way.

“I used to be a registered nurse. I was a case manager,” Norquist, now the director of Corporate Social Responsibility at Sentara Healthcare, told PatientEngagementHIT in an interview. “I worked in many of our hospitals, and I'll use this term 'back in the day' when I was in the emergency rooms, we used to have to use telephone books. We used to joke around about who had the best little black book to call every possible resource that we had at our disposal.”

“In the past, to be quite honest with you, we wouldn't always know about the resources or have them,” Norquist continued. “Or when we called, the phone might not get answered.”

Nurses have always been great at uncovering the social determinants of health that prevent patients from achieving their highest level of wellness. Through trusted patient-provider communication, clinicians can determine if a patient continually presents in the emergency department because she cannot afford the medication that could keep her chronic illnesses at bay, for example.

But the process of flipping through the phonebook, finding an employment aid that could connect the patient with a job and thus money in her pocket, and ensuring the patient actually chatted with them was arduous.

And in an era of clinician burnout and health tools that can help connect the dots for providers and patients alike, it was simply good sense to connect with an SDOH technology solution.

“We are a health system that has also a health plan,” Norquist explained, referencing Sentara’s health plan branch Optima Health. “Our health plan started with Unite Us. They were building that out for the community aspect. Then I started learning about this when I was a case management leader and thought, ‘How wonderful would it be for us to have referrals and resources at our fingertips?’”

That came especially as Norquist observed an increasing interest in the social determinants of health. Most clinicians recognize the role these social factors play in patient wellness and are looking to both uncover and address social determinants of health with their patients.

“More and more, health providers are coming out of the gate looking for ways to connect patients and their families to aspects of care that are outside the traditional hospital walls,” Norquist noted.

“Patients may be unemployed, for instance. The platform allows us to serve a greater population. We may be able to link a family member, for instance, to a job where these wouldn't be in our normal scope of work. But because of the availability of the resources being so accessible and at our fingertips, we can do that more easily and more holistically.”

The platform, which both Optima Health and Sentara now have built out on both the payer and provider ends, respectively, was developed in partnership with the Virginia Department of Health, Kaiser Permanente, Virginia Mental Health Access Program, and other area leaders. It aggregates community organizations for clinicians looking to refer patients to a certain social service.

For example, a clinician treating a patient demonstrating food insecurity could use the platform to look up a food bank near the patient’s home. This beats the old method in which a provider would have to hope the patient got to the food bank, Norquist said.

“Through the technology platform, you can enter that referral and see it get opened or closed, which gives the clinician a higher level of confidence that they're actually making the connection with the resource, versus just handing a sticky note to a patient with a phone number on it,” Norquist explained.

Of course, addressing social determinants of health needs won’t be as easy as scrolling through a list of social services providers, Norquist acknowledged. Actually uncovering that social need is one of the harder parts, largely because it hinges on patient trust and good patient-provider communication.

Focus groups have found patients fear being judged when discussing social needs with their providers, especially when they don’t perceive a direct link to health or wellness. When there’s a child involved, parents worry clinicians may turn them into child protective services if there is an issue.

Building a foundation of trust with the patient is an essential first step to ultimately making a social services referral, Norquist suggested.

“That starts with trust and having empathy and compassion and listening,” Norquist advised. “A lot of times we see people reacting and responding and maybe frequenting a higher level of care because they just don't divulge to us that they have a transportation issue, for instance.”

Through active, empathic listening, Norquist said providers can uncover that the patient can’t get a ride to a lower-acuity site.

“Through those conversations and gaining the trust of the patients and their families, clinicians learn that there may be other aspects of things that we can help with,” Norquist said.

Organizations also need to do the work with their community health partners, she continued. The referral platform is only as strong as the number of community partners on it, and building out that contact list is a two-way street.

As noted above, the referral platform was curated by key entities in Virginia, but now that Sentara is in the loop, Norquist said the organization can also engage with some of its existing community partners.

“We've been in the community for quite some time, and the relationships that we have with some of the social service agencies have been deep and rich,” Norquist said.

“When we explored the opportunity to look at Unite Us, we were meeting with, for instance, the free clinics and the food banks. We asked them, ‘Would you align with us in this journey so that we could have really a telescopic view into what our collective impact would be?’” she offered as example verbiage.

Norquist said Sentara doesn’t take the lead on every push out into the community. The organization is aware of where it lands on certain power hierarchies, meaning it knows certain community partners are better resourced for building out the network than Sentara might be.

That is a crucial step for a healthcare organization, as good community health partnerships hinge on a healthy balance of power.

Moving forward, Norquist said Sentara plans to engage with traditionally underrepresented community partners, the partners that might not be expected as resources.

“We're trying to build out our network around trusted community partners like churches and other folks that reach deep into the communities that might not otherwise be reached,” she said. “We're actually looking at extending and onboarding some church networks into Unite Us as well. We’re very early in that process.”

This is essential to Sentara’s goal of pursuing health equity, Norquist stated. By engaging partners who are not usually engaged, Norquist and team hope to engage patients who are also not usually reached.

“Now more than ever, the focus on reaching people who wouldn't normally be reached is incredibly important to us so that we can work through preventative medicine and overall quality of life for people in and around all of our communities,” she concluded.