Which Social Determinants of Health Lead to Low Care Quality?

The different social determinants of health have different impacts on healthcare quality, utilization, and outcomes, with new Humana data showing that some SDOH are more closely related to poor care quality while others are more closely related to high healthcare utilization.

For other SDOH, like social isolation and limited access to transportation, patients experience both poor care quality and high acute care utilization, the JAMA Network Open report showed.

Understanding the social determinants of health has become a high priority for both healthcare providers and payers. It has become clear that the environments in which people live, work, and play, have an impact on their well-being and health outcomes, but now, stakeholders are working on how to address SDOH.

This latest study looked at which SDOH have the biggest impact on health and well-being, as measured by care quality and acute care utilization, to better determine effective SDOH interventions going forward.

The Humana researchers, in partnership with experts from the University of California San Diego, zeroed in on over 21,000 Medicare Advantage beneficiaries with type 2 diabetes who answered a health-related social needs (HRSN) survey in 2019.

Of those beneficiaries, more than half (56.9 percent) had at least one SDOH reported in the HRSN survey. This finding was notable, the researchers pointed out, because that 56.9 percent figure is larger than the proportion of all Medicare Advantage beneficiaries reporting at least one SDOH (49.3 percent), indicating that those in the type 2 diabetes population are more likely to experience SDOH.

The most commonly reported SDOH included financial strain (73.6 percent), food insecurity (47.5 percent), and poor housing quality (39.1 percent).

But these social determinants of health had different potential to impact the health and well-being of the beneficiaries who experienced them. For example, experiences of loneliness, lack of transportation, utility insecurity, and housing insecurity were all linked to lower diabetes medication adherence, a key element of clinical quality.

Loneliness and lack of transportation were also linked to higher acute care utilization, like increased emergency room visits.

Food insecurity, too, was linked to higher acute care utilization, with individuals reporting food insecurity having higher rates of emergency department visits, inpatient encounters, and avoidable hospitalizations.

The researchers said that these findings can help healthcare organizations, payers, and public policymakers better determine macro-level interventions for SDOH among individuals with type 2 diabetes. Understanding that certain SDOH, like loneliness, have big impacts on both healthcare utilization and care quality may help stakeholders prioritize interventions.

“Community-based organizations and health systems can coordinate activities and cross-sector communication to expand opportunities for community members to reduce HRSNs and increase opportunities for healthy lifestyles,” the research team posited.

On a policy level, innovative payment models, incorporation of social supports into the clinical care team, and benefits flexibility for health plans could be helpful, they added.

Meanwhile, developing a deeper understanding of reported SDOH among individuals with type 2 diabetes, particularly through SDOH screening, can also have an impact on an individual level.

“In theory, collected information might then be used by clinicians and health care delivery organizations to improve care,” the researchers wrote. For instance, for patients who screen positive for an HRSN, practitioners can adjust care decisions to reduce the impact of the unmet need, help to connect to appropriate social services, or advocate for more resources.”

This data comes as others in the healthcare industry try to determine the most common social determinants of health. Uncovering the most common SDOH will help experts better tailor interventions and more judiciously target their resources.

A February 2021 patient survey from the Root Cause Coalition found that economic stability and access to quality healthcare are the most common SDOH, reflecting some of the results of the Humana data.

The Root Cause Coalition survey asked patient respondents to rank economic stability, access to quality healthcare, education access and attainment, neighborhood and environment, and community context and social isolation by the extent to which they experience that SDOH.

Thirty percent said economic stability was their most pressing SDOH, while 27 percent listed access to quality healthcare.

Those answers indicate that The Coalition, and other organizations targeting social determinants of health, are on the right track, according to Barbara Petee, The Coalition’s executive director.

“This research affirms our mission to achieve health equity – and its urgency – and provides proof points for our advocacy priorities – never more important and simultaneously magnified than during the global pandemic,” Petee explained at the time of the report.

“The Coalition’s cross-sector approach is also front and center in these findings, with Americans reporting that those responsible for addressing social determinants include federal agencies, all levels of government as well as health care, public health departments and community-based organizations, among others.”