May 15, 2018

More than 80% of doctors say it isn't their job to fix social determinants of health. (But that's not quite as alarming as it seems.)

Daily Briefing

    Editor's note: This story was updated on June 13, 2018.

    Doctors generally acknowledge that social determinants of health affect their patients—but an overwhelming majority of doctors say it is not their responsibility to address them, according to a recent white paper by Leavitt Partners.

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    Paper details

    For the paper, Leavitt Partners surveyed physicians between June 2017 and July 2017 to:

    • Assess current barriers to addressing social determinants of health in the clinical setting;
    • Examine physician attitudes toward social determinants of health; and
    • Recommend how to address social determinants of health without contributing to physician burnout.

    In total, 621 physicians responded to the survey. The sample population included

    • Primary care specialists (35% of respondents);
    • Non-surgical specialists (31% of respondents);
    • Surgical specialists (18% of respondents);
    • Hospitalists (10% of respondents); and
    • Proceduralists (6% of respondents).

    Key findings

    According to the paper, a majority of respondents said their patients would benefit from assistance with social determinants of health. In particular, researchers found:

    • 66% of respondents said they believe assistance arranging transportation for health care would greatly or moderately benefit their patients;
    • 54% of respondents said they believe increasing patients' income would greatly or moderately benefit their patients;
    • 48% of respondents said they believe help getting suf­ficient food would greatly or moderately benefit their patients; and
    • 45% of respondents said they believe help getting affordable housing would greatly or moderately benefit their patients.

    However, few respondents considered addressing social determinants of health to be their responsibility, with:

    • 93% of respondents saying they do not believe physicians or insurers are responsible for helping increase patients' income;
    • 91% of respondents saying they do not believe physicians or insurers are responsible for helping patients get affordable housing;
    • 84% of respondents saying they do not believe physicians or insurers are responsible for helping patients get sufficient food;
    • 69% respondents saying they do not believe physicians or insurers are responsible for helping patients with transportation; and
    • 44% of respondents saying they do not believe physicians or insurers are responsible for providing information about health insurance, including public coverage.

    According to the paper, respondents frequently said patients have other resources available to address their social needs. For example, more than 30% of respondents said there are resources for patients to get sufficient food.

    Moreover, several respondents said their ability to address specific social determinants of health was limited. For instance, 48% of respondents said helping their patients get affordable housing was not within the capabilities of their physician­ offices. In addition, respondents said patient appointments are not long enough to address social needs and insurers do not compensate for such services.

    Recommendations

    According to the researchers, success in value-based payment models will increasingly require that patients' nonclinical needs are addressed. To facilitate the incorporation of social determinants of health into the clinical setting, the researchers said:

    • Care and technology strategies aimed at addressing social determinants of health must ease—rather than exacerbate—physician burnout;
    • Obstacles to addressing social determinants of health within fee-for-service payment models should be resolved;
    • Employers, policymakers, and other stakeholders outside of the clinical care team should play a role in improving communities by addressing social determinant of health; and
    • Increased infrastructure and public health funding is needed at the local levels to support clinical efforts to tackle social determinants of health (Castellucci, Modern Healthcare, 5/9; Leavitt Partners release, 5/9; Leavitt Partners report, 5/9).

    Advisory Board's take

    By Tomi Ogundimu, Practice Manager, Population Health Advisor, and Darby Sullivan, Analyst, Population Health Advisor

    The headline data points in this survey—including that more than 80% of physicians don't consider tackling major social determinants of health to be part of their job—certainly sound alarming. The good news, though, is that the results aren't quite as worrying as they seem.

    First of all, physicians are rarely in charge of their organization's community resource connection effort, especially if they are non-primary care physicians (who made up 65% of the study's respondents). While all health care staff, including physicians, should be conscious of the impact of the social determinants of health, the primary responsibility for addressing social needs is often held by non-physician staff who are involved in discharge planning, transition support, and ongoing care management. The RN care managers, social workers, community health workers, and others who typically own this task can tap into their relevant expertise and thereby help physicians focus their limited time on clinical care.

    Still, it's concerning that many physicians don't realize that members of their care team should help in meeting non-clinical needs at all. This misconception can be especially worrisome coming from primary care physicians, whose teams are most suited to helping patients address the social determinants that impact their health. Our research shows that innovative community partnerships to address non-clinical factors work best when they're championed by engaged, respected clinical leaders—who helps obtain leadership buy-in and cascade culture change across their teams.

    Population and community health leadership should therefore make sure that physicians are aware of the impact of social determinants and engage them in the cause. Need help knowing where to focus your efforts? Use Population Health Advisor's toolkit to build your strategic plan for non-clinical resources.

    Download the Toolkit



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    Employed medical groups must strengthen Medicaid patient access to physician services. This briefing summarizes the medical group’s three discrete—though not mutually exclusive—options for doing so.

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