Two Questions Before Health Care Organizations Plunge into Addressing Social Risk Factors

Fichtenberg, Caroline; Fraze, Taressa

doi:10.1056/cat.22.0400

Cited by 9 publications

(7 citation statements)

References 20 publications

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“…2 As a result of such policy decisions in the face of tremendous evidence of the influence of SDOH on health outcomes, many healthcare organizations have moved towards measuring or addressing SDOH once individual patients contact the healthcare system. [20][21][22][23][24] Other hospital systems strive to reach beyond the exam room and foster deeper community partnerships. 21,25 While these efforts are regarded as laudable by many, they provoke controversy regarding the responsibility of health systems in directly confronting SDOH.…”

Section: Discussionmentioning

confidence: 99%

“…24,[26][27][28] Screening and referral to existing public social services, which are woefully underfunded and often unable to provide needed resources, is unlikely to produce population-level shifts in health. 22,23 At the same time, more innovative, community-centered approaches are only available among select hospital systems. 25 Considering the existing literature and our findings, point-of-care intervention on individual social needs may miss important opportunities for primary prevention, which more widespread social services could provide.…”

Section: Discussionmentioning

confidence: 99%

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sSocial Determinants of Health and Cumulative Incidence of Mortality among U.S. Adults without Major Chronic Diseases

Claudel,

Verma

2024

Preprint

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Background: Social determinants of health (SDOH) are widely known to contribute to poor health outcomes and premature mortality among individuals with prevalent diseases. Understanding the impact of SDOH on mortality among adults without major chronic diseases may inform public policy in the United States (U.S.). Methods: We conducted a prospective observational study using the National Health and Nutrition Examination Survey data (1999-2018) among 11,413 adults without hypertension, diabetes, hyperlipidemia, severe obesity, chronic kidney disease, cardiovascular disease, chronic respiratory disease, cancer, liver disease, arthritis, hepatitis B or C, human immunodeficiency virus, or pregnancy. We calculated 15-year adjusted cumulative incidences of all-cause mortality by baseline SDOH and described the trends in the prevalence of adverse SDOH. Results: The mean(SD) age was 34.9(11.2) years. Over a median follow-up of 10.3 years, 275 participants died. The prevalence of low educational attainment decreased over the study period from 19.8% to 12.1%, while the prevalence of food insecurity increased from 11.5% to 23.1%. The 15-year adjusted cumulative incidences of all-cause mortality were 5.6% (95% CI, 2.8-8.5), 5.2% (95%CI, 3.2-7.3), 4.9% (95%CI, 2.7-7.2), 4.0% (95%CI, 2.8-5.2) for participants who had < 100 % of the federal poverty level, below high school education, food insecurity, and were born in the U.S., respectively. In the final adjusted model, a 1-point increase in cumulative SDOH score was associated with 33% increased risk of all-cause mortality. Conclusions: In this study of community-dwelling U.S. adults without major chronic diseases, we demonstrate a pronounced increase in all-cause mortality associated with adverse SDOH.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

sSocial Determinants of Health and Cumulative Incidence of Mortality among U.S. Adults without Major Chronic Diseases

Claudel,

Verma

2024

Preprint

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“…A key concern with some approaches to multisector collaboration is that patients are often well aware of existing services, and HSOs are already operating at capacity. 14 This suggests that multisector collaboration approaches will be unlikely to make a meaningful impact relative to the status quo without new resources and support for capacity building. 15 Participants echoed these concerns and endorsed the focus within HOP of supporting capacity building and expanding service offerings, particularly for areas with fewer resources before HOP.…”

Section: Discussionmentioning

confidence: 99%

“…The findings of this study are consistent with and expand on the results from prior work. A key concern with some approaches to multisector collaboration is that patients are often well aware of existing services, and HSOs are already operating at capacity 14. This suggests that multisector collaboration approaches will be unlikely to make a meaningful impact relative to the status quo without new resources and support for capacity building 15.…”

Section: Discussionmentioning

confidence: 99%

Benefits, Challenges, and Opportunities in Addressing Medicaid Beneficiaries' Non-Medical Risks to Health: A Qualitative Analysis

LaPoint,

Vu,

Ricks

et al. 2024

Journal of Public Health Management &Amp; Practice

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Context: North Carolina's Healthy Opportunities Pilots (HOP) is a Medicaid 1115 Waiver program that seeks to address nonmedical risks to health for Medicaid beneficiaries through multisector collaboration. Among other stakeholders, HOP involves collaboration between human services organizations that deliver interventions, network leads, which establish and oversee the human services organizations within a region of the state. Objective: To understand how employees at human services organizations and network leads prepared to deliver HOP services. Design: Qualitative analysis of semistructured interviews. Interviews were conducted between April and June 2022. Interviews were recorded, transcribed verbatim, coded thematically, and analyzed using a conceptual model derived from the consolidated framework for implementation research. Setting: Organizations within North Carolina counties participating in HOP. Participants: Employees of human services and network lead organizations across all 3 HOP regions of North Carolina. Results: The researchers interviewed 37 participants. Overall, organizations experienced benefits from HOP participation, including capacity-building resources, flexibility in allocating resources, and creating community-wide enthusiasm for addressing nonmedical risks to health. There were also key challenges. These included the time needed to build capacity, adjustments to the work processes and regulations inherent to multisector collaboration, geographic variation in availability of services to offer, and the difficulty of addressing different needs. Finally, participants recognized substantial opportunities that HOP presented, including membership in a more extensive network, exposure to a learning community, and a more sustainable funding source. Conclusions: The perspectives of individuals preparing to deliver HOP services offer important lessons for those developing and implementing large-scale programs that can address nonmedical threats to health.

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“…This form of multisector collaboration is perhaps epitomized by the growth of 'screen and refer' programs, in which an assessment for health-related social needs is made by health care payors or producers, and then a referral to address needs identified is made to community-based social services organizations. 21 I believe that multisector collaboration is currently the dominant approach taken by US government agencies, health care providers, and health insurers. Prominent examples of the multisector collaboration approach include the National Strategy on Hunger, Nutrition, and Health, the Centers for Medicare and Medicaid Services' Accountable Health Communities model (which served over 1 million Medicare and Medicaid beneficiaries) and subsequent models such as ACO REACH (Realizing Equity, Access, and Community Health), state-level Medicaid 1115 waiver programs, initiatives among health care organizations and private health insurers, and calls from both the Centers for Disease Control and Prevention and the National Academy of Medicine.…”

Section: What Is Multisector Collaboration?mentioning

confidence: 99%

Multisector Collaboration vs. Social Democracy for Addressing Social Determinants of Health

BERKOWITZ

2023

Milbank Quarterly

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Policy Points Multisector collaboration, the dominant approach for responding to health harms created by adverse social conditions, involves collaboration among health care insurers, health care systems, and social services organizations. Social democracy, an underused alternative, seeks to use government policy to shape the civil (e.g., civil rights), political (e.g., voting rights), and economic (e.g., labor market institutions, property rights, and the tax‐and‐transfer system) institutions that produce health. Multisector collaboration may not achieve its goals, both because the collaborations are difficult to accomplish and because it does not seek to transform social conditions, only to mitigate their harms. Social democracy requires political contestation but has greater potential to improve population health and health equity.

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Two Questions Before Health Care Organizations Plunge into Addressing Social Risk Factors

Cited by 9 publications

References 20 publications

sSocial Determinants of Health and Cumulative Incidence of Mortality among U.S. Adults without Major Chronic Diseases

sSocial Determinants of Health and Cumulative Incidence of Mortality among U.S. Adults without Major Chronic Diseases

Benefits, Challenges, and Opportunities in Addressing Medicaid Beneficiaries' Non-Medical Risks to Health: A Qualitative Analysis

Multisector Collaboration vs. Social Democracy for Addressing Social Determinants of Health

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