Healthcare leaders have been turning their attention to poor nutrition, homelessness and lack of transportation, among other factors affecting people’s health.
But to make the most of what it learns, the industry needs a unified strategy for collecting and applying information about those factors, known collectively as social determinants of health. Current data collection efforts are hindered by a lack of standardization and gaps in data, according to a report issued in December by the nonprofit Center for Open Data Enterprise, or CODE, in Washington, D.C.
The message comes as policy makers grapple with shortening life spans in some areas of the U.S, coupled with high levels of obesity, substance abuse and infant mortality.
The resulting geographic disparities have led some to argue that a person’s ZIP code may be as important as their genetic code in predicting health risks, a point echoed in the report’s foreword, written by Admiral Brett Giroir, assistant secretary for health in the U.S. Department of Health and Human Services.
“While the emphasis on access to clinical care and the quality of that care is important, they account for only about 20 percent of health outcomes,” Giroir wrote. “Everything else is wrapped up in air and water, housing and transit, faith, family and social support, community and safety. We will never solve our healthcare spending addiction, or our progressive degradation of health, unless we focus on what causes 80 percent of the poor health outcomes in this country.”
The report is based on a roundtable CODE held in collaboration with the Office of the Chief Technology Officer of HHS. About 80 participants – representing industry, academia and government – discussed how to use data on social determinants of health to improve health outcomes.
The report’s top recommendation is for the federal agency to develop a data strategy around social determinants of health. The strategy should focus on three goals:
- Defining and standardizing data on social determinants;
- Supporting local and state-based decision makers;
- Creating a sustainable infrastructure for collecting data, including financial incentives for payers, providers and community-based organizations.
Electronic health records may allow for capturing data on social determinants, the report said. But the data is often left out due to inconsistencies around medical billing codes and payer models, among other factors.
Providers and payers also may have to beware of potential ethical issues, such as profiling or excluding people who live in high-risk areas. The report describes the potential practice as “healthcare redlining,” reminiscent of a phrase associated with mortgage lenders who avoided doing business in minority and low-income communities.
The report also cites numerous organizations that are collecting data on the social determinants and, in some cases, acting on them. Examples include a partnership between ride-hailing service Lyft and the University of Southern California’s Center for Body Computing. Over a three-month period, Lyft provided unlimited free rides to 150 seniors. Roughly 31% of the rides were for visits to doctors. Seniors used the rest for fitness, social and leisure activities – and reported a significant increase in their quality of life, according to the report.
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