Transcription:

Alyne: MetaStar Health IT Radio is a podcast series that features consulting content experts and covers topics regarding the Wisconsin Medicaid EHR Incentive Promoting Interoperability Program formerly Meaningful Use as well as a behavior health technical assistance initiative. Episodes covered will guide your practice, clinic, hospital, or hospital system through the complex federal state requirements of the PI program

MetaStar has helped more than 2000 providers attest to promoting interoperability as Wisconsin's regional extension center since 2010 and continues to provide attestation assistance and audit preparation as a consulting service.

I'm Alyne Ellis, and we're joined today by Lanette Hesse, a project specialist at MetaStar. She will be sharing information about social determinants of health. Welcome, Lanette.

Lanette Hesse: Well, thanks for having me.

Alyne: So let's start by talking about social determinants of health, and I guess the acronym for that is SDOH. And can you define what that is for us?

Lanette Hesse: For sure. We're hearing a lot about inequities in healthcare and really during the COVID-19 pandemic, this has been highlighted. And a lot of this has to do with SDOHs or social determinants of health. So it's really making a big appearance, not only in the healthcare environment, but also mainstream media.

So let's start by laying the groundwork around what really is the definition of SDOH or social determinants of health. I'm going to go ahead and use the definition from the Healthy People 2030 report that's available on the health.gov website. And this was put out by the US Department of Health and Human Services. And the report is using place-based framework that outlines five key areas of social determinants of health.

So let's start by that formal definition. Social determinants of health are really conditions in the environment where people are born, they live, work, play, worship and age, and those conditions can affect a wide range of health, functioning and quality of life outcomes and risks. So really SDOHs are divided into five domains or categories.

Alyne: So before we talk about those categories, let's talk about why this data is important for people.

Lanette Hesse: For sure. It's important for us because in a nutshell, it really translates to better health and better health outcomes for all. So this isn't a new concept, but really as the healthcare environment transitions from volume to more of a value-based care, providers and other stakeholders are investing in strategies that will lead to improved quality of care and reduced overall healthcare costs.

So actually, I'm attending two national virtual conferences this week, not quite simultaneously, but one of them is the ONC or the Office of National Coordinator for Health Information Technology and the other is the Mid-Atlantic Telehealth Resource Center Summit. And at both of these, we've seen the same graphic around social determinants of health. And that really is based on a study that came out that really talked about what are the different factors that affect our health outcomes as patients.

And really this study is highlighting that what we might traditionally think of as a doctor visit or clinical care really only affects our outcomes by 20%. So that other 80% comes from different factors outside of that healthcare visit that may stem from social or economic factors, maybe health behaviors or the physical environment. In other words, 80% of our healthcare outcomes come outside the clinical environment. This has really highlight the need for collaboration among different community partners. So we might have thought traditionally of going to our doctor for healthcare outcomes, but really we're finding the need to integrate behavioral health, social services into this equation just to name a few.

Alyne: So where does the data regarding social determinants of health come from?

Lanette Hesse: So data around social determinants of health can come from multiple outlets when we're evaluating SDOHs. So you can talk about the electronic health record or EHR. We have medical claims data, data around your ZIP code, county level data, screening tools, and surveys and other social data.

Just to use an example of this, this year during the pandemic, a lot of us, most of us, were doing social distancing at home, and really we were utilizing virtual visits or telehealth for our healthcare. Well, one of the issues that this raised is does this create a digital divide for people who might not have access to technology or broadband, for instance, for video or even audio visits?

So a new buzzword phrase in the healthcare might be that your health depends more on your ZIP code than your genetic code. And a tool that people are using to predict this is called the SVI tool or the social vulnerability index.

Alyne: So you talked about the five domains or categories of SDOH and what are they specifically?

Lanette Hesse: Yeah, they've really broken down the five categories of social determinants of health. And I'm going to go over each of those five and give some examples of each. So that first domain is called economic stability. It is what it sounds like. It's really using poverty, employment, your food and housing instability or insecurities to define that category.

The second category is really based on education. So some examples of that are what are your education opportunities? Is that a high school graduation, higher education? Do you have any language or literacy barriers when it comes to education?

The third component is called health and healthcare. And this is really based on your access to health care and primary care and what, during that access, is your health literacy. An example I'm going to use for this is my 80-year-old mother that lives in rural Iowa. She has some heart issues and frequently sees a cardiologist. However, her cardiologist is located an hour from her house, so transportation is sometimes a barrier for her.

Moving on to the fourth category or domain is neighborhood and built environment. So the examples of this really are around access to healthy food, your quality of housing and your exposure to environmental conditions and maybe crime or violence in the place where you live.

And the fifth and last category is called social and community context. So this really takes into account the factors around social cohesion, civic participation, any barriers with discrimination and/or incarceration.

Alyne: So you've mentioned the social vulnerability index, SVI. What is that? And how can it be used?

Lanette Hesse: Yeah, this is kind of interesting. It's interesting because we can use it as a predictor for social determinants of health. However, it was actually established for public health officials and emergency response planners when they were looking at emergencies like hurricane or fires. And it basically takes data from your ZIP code location and divides it into categories of items that we would consider social determinants of health. And that website is svi.cdc.gov.

Another really interesting tool that takes into account your ZIP code is one that's called FindHelp.org. Another name for that is AuntBertha.com. This website, you can use it, you just type in your ZIP code and it'll bring up any social services in your area. I know I've recommended this to my mom for her to look up some of her transportation opportunities in her area.

Alyne: Well, that's really interesting how to use this data. So what are your thoughts about some of the strategies or roadmap for implementing SDOH?

Lanette Hesse: There are a lot of components around SDOH and the really great thing is there's already a lot of framework and toolkits out there. So I would really suggest starting with crafting an evidence-based strategic plan around your implementation of SDOHs. So, like I mentioned, there are a lot of tools and toolkits already out there. Another really important component is going to be interoperability, so how do you share that data with some of your community partners.

I want to mention some of these tools and toolkits. I want you to keep in mind that we'll have a transcript of this podcast because it'll start sounding a little bit like alphabet soup here, but there're really some great resources already out there. And one of them includes the tool called the PREPARE Tool. There's another tool called IMPAC, I-M-P-A-C. And for rural providers looking to implement social determinants of health, there's a toolkit on RuralHealthInfo.gov. It's called the RHIhub toolkit. So there are multiple places to start. I really wouldn't recommend starting from scratch. I'd use some of these evidence-based toolkits as a starting point.

It also makes me want to bring up the fact of the Gravity Project. This is a collaborative, which is taking place where a group of folks are working to establish those data standards, and that will help with promoting the use and exchange around SDOHs. There's also a lot of information out there for establishing a business case around SDOHs.

Alyne: So what kinds of things should providers be thinking about when it comes to SDOH?

Lanette Hesse: As I mentioned a little bit earlier, there are so many different facets to this. So I would really start with a few key questions. And that is, how might having the data on a patient's social determinants of health conditions affect how your office or organization is going to coordinate healthcare for that patient?

Another thing to keep in mind is how can your practice and incorporate the SDOH collection and assessment into your workflow. So once you identify those social determinants or social factors, how will that impact any clinical outcomes? There are a lot of considerations around privacy and security barriers that might exist.

And just this year in 2021, a new set of ENM codes were introduced and those are called Z Codes or Z as in zebra codes and those include specific SDOH definitions.

Alyne: And where can listeners go, Lanette, for more information or for assistance regarding social determinants of health?

Lanette Hesse: It can be really overwhelming to start this project of this magnitude and it contains so many facets. So really a great place to start would be our website, which has the transcript of this podcast including the resources I've mentioned. So that's MetaStar.com/podcast, M-E-T-A-S-T-A-R dot com slash podcast.

Alyne: Well, thank you so much, Lanette. I'm amazed at how much this data can really help individuals to live a healthier life.

Lanette Hesse: Thank you for having me and enjoy your day.

Alyne: Lanette Hesse is a project specialist at MetaStar. For more information on this topic and to access resources mentioned, please visit MetaStar.com/podcast. That's M-E-T-A-S-T-A-R dot com forward slash podcast.