Opportunities for Providers to Address SDOH

Doctor with senior woman in nursing home

In our first blog we discussed the what the Social Determinants of Health (SDOH) are and how they impact the overall health and wellness of the population. Being aware of these factors is important for the improvement of health outcomes, but that is just the first stephow can home care providers take this information and turn it into action?  

Medicaid services and health coverage are provided to over 75 million low-income Americans, including many individuals with complex, chronic, and costly care needs. Many of these individuals receiving care are facing challenges related to SDOH, including but not limited to access to nutritious foods, affordable and accessible housing, transportation, safe neighborhoods, strong social/community networks, along with quality education and opportunities for meaningful employment.  Challenges within these specific areas can lead to disproportionately lower health outcomes, higher cost of care and can exacerbate health disparities for a broad range of populations.  

Home-and-community-based-services (HCBS) are already extremely beneficial SDOHthese services allow people to receive the care that they require within the home rather than in a facility. That alone benefits individuals receiving this care; however, it is important that the caregivers are aware of other factors and intervene when necessary. Examples of SDOH factors that can be addressed in the home are:  

  • Nutrition goals and plansensuring that individuals have access to the proper foods to meet their health and wellness goals. 
  • Social and community supportcaregivers can gauge and assess whether each individual has support and if needed, can help them bridge this gap by enrolling them in a program or providing some other means of support.  
  • Housing: paying attention to needs around the home and helping the individual address these needs directly or through a social support or service-based organization 
  • Environmental factors: ensuring the home-based environment is safe for all individuals and reporting concerns when they arise.  

Awareness is key when addressing and influencing SDOH but recording and reporting this information is also crucial, however, action is paramount. Utilizing tools such as Electronic Medical Records, Electronic Visit Verification and others can help gather information and ensure that all individuals have their needs met and addressed. Organizations can also use these tools by setting up alerts and reports to ensure that no one falls through the cracks. Addressing health and wellness in a holistic way will ensure that better care is provided to every individual and that all needs are being met, regardless of social and/or economic factors. 

SDOH can also be addressed on the payer level- how can states and managed care organizations influence SDOH and the improvement of health outcomes? In our next blog, we will address programs and initiatives that payers are implementing to address and influence SDOH.  

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