Undoubtedly social determinants of health impact health outcomes. According to a study, medical care accounts for only 10-20 percent of healthcare outcomes. Infact, 80-90 percent is attributed to demographic, environment and socioeconomic factors. Also, study confirms that most patients have at least one social determinant of health (SDoH) challenge.

A combination of publicly available county, zip code data and member-level social determinant information can significantly improve the effectiveness of care planning for members, if it’s made easily available to care managers.

Let’s say for example, the payer care manager responsible for a member with congestive heart failure, hypertension, type 2 diabetes, and social determinant indicators for housing and transportation could use that information, drilling into the patient record to see information such as:

The member has moved three times in the past 12 months,
The closest in-network pharmacy is almost a mile away from the member’s residence,
There is no licensed driver in the household.

This social determinant information suggests that transportation is the reason the member has not been able to recently fill prescriptions. Thus, the payer care manager would contact them to confirm if they don’t have access to a car and the distance to the nearest bus stop.

Now, the care manager can arrange for medications to be sent to the patient’s home and create a referral to a social services organization that could provide transportation to physician visits.

Care managers can identify and address populations or subpopulations with social determinant gaps. For example, an employer with a high prevalence of diabetes and prediabetes among its employees can work along with the payer care manager to determine if social determinant barriers are impacting employees’ ability to follow lifestyle changes needed to manage diabetes and prediabetes. These barriers could be absence of parks, playgrounds, hunger or access to health food options.

As a solution to this challenge the employer may choose to include healthier options in the company cafeteria, replace vending machines with fruit bowls or install fitness equipment in the workplace.