With more than 1,000 attendees from hundreds of organizations, we received many questions from members across the industry. Here are our answers to your peers' questions about how substance use care fits into a social determinants of health strategy and how organizations under fee-for-service can measure community health initiative success.
1. How does substance use care fit into efforts to address social determinants of health?
Substance use treatment is typically carved out of traditional conceptions of the social determinants. This is purposeful. When substance use disorder (SUD) isn't treated as a clinical need like any other, patients are more likely to experience stigma and less likely to access affordable, quality care.
Of course, SUD already isn't treated as a clinical need in many cases—but rather, a moral failing. This is why SUD care is rare, expensive, and much harder for patients to access than other specialty services. Further, some of the root causes of substance use are associated with psychosocial needs, like adverse childhood experiences, trauma, and economic stagnation.
Substance use care falls more under the auspices of health equity than social determinants of health. But any population health department interested in supporting patient self-management and reducing total cost of care should address these needs holistically by targeting root causes.
2. What key performance indicators can organizations under fee-for-service use to measure success across community health interventions?
Organizations primarily under fee-for-service payment models can't rely on the same definitions of success as those under value-based care. However, organizations across risk models can select short-term process measures as well as long-term outcomes measures. Because these efforts take a number of years to show a return, it's a good idea to identify and monitor process metrics to see where programs are trending in the initial stages.
Refer to the metric picklist below to align community health initiatives with business imperatives under fee-for-service.