The impact of social determinants of health (SDOH) as drivers of medical utilization, cost, and health outcomes is both widely researched and acknowledged. This growing body of evidence attributes as much as 40 percent of health outcomes to SDOH such as housing, education, poverty, and nutrition and that as much as a third of the deaths in the United States can be accounted for by social factors. The influence of SDOH is particularly pronounced in vulnerable high-need, high-cost (HNHC) populations with single to multiple functional limitations.
Despite the widespread acknowledgement of the importance of addressing SDOH to improve outcomes and lower medical costs, observed investments tend to be modest in scale and temporary, often funded through time-limited grants or launched as pilots without a long-term strategy. Few healthcare organizations have incorporated the services that target SDOH directly into their ongoing business operations without any requirement of ongoing outside financial support.
In response to these observations and as part of their ongoing mission to support the promotion of accessible, high-value, and affordable care for HNHC populations, The Commonwealth Fund worked with KPMG LLP (KPMG) to explore the current landscape of investments targeting SDOH as well as approaches to accelerate the uptake of SDOH investments into healthcare business operations. In the period between August 2016 and September 2017, KPMG interviewed 33 healthcare payer and provider executives from across the United States, performed extensive literature review, and convened both an Advisory Council and a Social Services Forum to obtain insights and feedback on the formulated hypotheses and suggested approaches.
The intended audience for this guidebook is all payer and provider organizations that currently bear some form of risk for managing total costs of care for a distinct (sub) population. While we focus mainly on organizations that are responsible for managing HNHC populations, the steps and practical approaches laid out in this guide may be applied by any organization (payer or provider) that either currently bears risk or is in the process of moving to risk-based remuneration models for a covered population. While employers are not the main intended audience of this guide, the principles laid out in this text can apply to employers just as they do to payers given that employers set the terms (and pay the costs) of the care contracts for their employees, whose health is affected by social determinants.