According to RJ Briscione, focus group director, addressing the social determinants of health (SDOH) requires several critical elements: having reliable, up-to-date data about people’s social needs; being on the ground and talking to people face to face; The ability to adapt and make changes.
Briccioni directed a panel on how meeting these social needs affects health equity last month State of Repair Oregon Health Policy Conference 2022. He was joined in the session by Jess Soltis, director of social health for Kaiser Permanente Northwest, and Richard Bruno, senior medical director for clinical care at Central City Concern, an organization serving homeless individuals in Portland.
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The group conversation had one common topic: data. Advocates across the healthcare sector For a long time Stronger and more coordinated health data collection as critical to effective management of SDOH. Committee members doubled down on this.
“How do we collect this data, and how do we make sure we get to the people who really need it, and not just the people we see coming into our clinics on a daily basis?” Soltesz said.
Soltesz noted that there are “hidden groups” that current SDOH outreach strategies do not reach, leaving the sector with incomplete data about their social needs. Because people with SDOH challenges tend to have access to the health care system at lower rates, she said, it is critical that the health care system make proactive, intentional outreach to individuals.
“Unless we specifically target this population, we won’t have a good idea of what needs are really there,” she said.
A big part of this is incorporating more community-focused intervention approaches, such as non-English language data collection options and community health workers. She said community health workers need to be involved for longer periods of time to get to the root of individuals’ social needs.
“in our world, [SDOH are] It won’t even show up [patients] They appear with a kind of extreme need in our medical system,” Priscione said. “That’s the only way we have to measure things, unfortunately.”
Soltesz emphasized that the health care system does not need to create a new social data collection structure, but rather it needs to partner with community-based organizations (CBOs) that are already doing this work and leverage the data they receive about beneficiaries to carry it out. SDOH interventions.
“We can’t just ask to ask, we have to ask for a reason,” Soltesz said of SDOH data collection.
Discussing the ways in which COVID has affected data collection efforts, Briscione and Soltesz highlight the digital divide as a salient hurdle. When organizations rely on electronic communication methods to identify social needs, only those with access to the necessary technology or sufficient technological knowledge can participate. Priscione noted that these are often “wealthy whites”.
For example, when Briscione was facilitating COVID vaccine distribution during his tenure at Aetna, his team picked vaccine retailers that were near the largest Black and Brown populations in order to target those disadvantaged populations and make sure they got the vaccine.
He discovered, however, that the only people signing up for appointments were those with the technology to enable them to book vaccine appointments online — not the intended underserved population.
To mitigate this, Briscione and his team instead distributed the vaccines through trusted local community organizations that serve these communities, such as black churches. His team has also purchased vehicles to conduct a mobile vaccine distribution, rather than relying on an online registration process.
Soltesz added that it is important to engage with communities and learn directly from them about how best to implement projects such as distributing vaccines, rather than Presenting a pre-made plan to communities without consulting their members
The team also emphasized that data collection is only one piece of the puzzle. Data also needs to be synthesized and used in a meaningful way. Bruno pointed out that there are many ways to aggregate data on SDOH—assessments of community health needs, providers asking patients directly, payers asking beneficiaries—but there aren’t many effective ways to share them and use them to effect change.
He said this presents an opportunity for collaboration between the different organizations that collect the data. He urged stakeholders to keep abreast of SDOH data constantly emerging from the pandemic and to consider ways to use this data to create collaborative solutions.
Speakers also cited some recent examples of successful SDOH-focused initiatives in Oregon.
Bruno discussed how housing has been key during COVID, and how providing housing support can help protect Oregonians from the risks of overcrowding during public health emergencies like COVID. He registered the city of Portland Safe comfort villages As a successful way the government has addressed the housing shortage for thousands of unhoused individuals in Portland post-COVID.
Through this project, the city implemented a “capsule system” in which zones are divided, or “pods” for unhoused individuals that contain necessities such as heating and housing. This allowed these individuals to maintain social distancing practices while maintaining access to essentials.
Briscione and Soltesz discuss Health Share Oregon’s successful efforts to use data to reach members who may be at risk from heat or climate-related health effects and We offer them Medicaid-covered AC units. Health Share Oregon reached out to members with a history of respiratory illness, etc. and ended up distributing about 300 air conditioning units to Medicaid beneficiaries who needed them during this summer’s heatwave.
Briscione also discussed Aetna’s partnership with Feeding South Florida, which has set up school food pantries for food-insecure families to receive groceries. They also provided a survey in Spanish of the social needs of the beneficiaries who participated in the program.
Once his team determined that transportation was an outstanding issue for these families (many families had limited access to transportation to pick up food and/or bring it home), they implemented mobile “farms” in which vehicles transported food to a network of local clinics that were closer to The families you need.
Briscione said this project significantly reduced the A1C levels of the target population.
“I think it’s about a paradigm: start with something, find a good partner, you’ll have to adapt and figure out what you want to measure, and stick with it,” he said.