Social drivers (also known as determinants) of health (SDOH) are the conditions in the environment where people live that affect quality of life, health outcomes, and risks. They include things like poverty, education level, access to health care (or lack thereof), etc. These factors impact our patients’ health before, during, and after any health care encounter. They also contribute to inequities and disparities in both care and outcomes. To truly deliver patient-centered care that accounts for each patients’ unique circumstances, we must consider how social drivers of health influence their lives.
One way to better understand any challenges your patients face – as well as assets in their communities, families, and homes – is to ask questions about these socio and economic factors. With this information, you can better partner with patients, their families, and care team members across your organization to design a care plan that addresses the non-medical factors that can play a huge role in the healing process.
The Centers for Medicare & Medicaid Services (CMS) worked with organizations across the country through the Accountable Health Communities Model to test approaches to asking patients about their health-related social needs (HRSNs). This effort led to the creation of the Accountable Health Communities Health-Related Social Needs Screening Tool, which includes 10 core questions about:
- Housing instability
- Food insecurity
- Transportation problems
- Utility help needs
- Interpersonal safety
Participants in this CMS Model tested different approaches to administering the screening tool and referring patients to available services to address their needs. These sites learned a lot. Hospitals who are now setting up their own processes to screen for and address SDOH can learn about strategies to make the business case for addressing SDOH, align payer and provider activities to address SDOH, expand and scale efforts to address SDOH, and more.
The CMS AHC HRSN screening tool is just one of many screening tools available to use. Whether you use the CMS AHC HRSN or another tool, any information you can gather about the non-medical factors your patients face will help you develop care plans that will more effectively promote healing and health.
Are you passionate about identifying and addressing SDOH? Are you looking for a community of driven health care workers with the same goal, and who are facing the same challenges? We have just what you’re looking for.
Our SDOH CLIC community is filled with over 2,000 health care workers that are determined to make a difference in this world. Join this passionate group to share your successes, learn from others, and have a shoulder to lean on when things get tough. We can’t wait to have you!