Asmita Vadali | August 2018

In the first part of our Population Health blog series, we examine the social determinants of health, what we understand about them, what we still need to learn, and how we can apply these findings to the ultimate goal of value-based care.

In 2016 the United States spent $3.3 trillion on healthcare–about 17.8% of the national Gross Domestic Product–while the average spending for all other high income countries sat at around 11.5%. Despite this 6% increase in spending, the US suffers from lower rates of insurance coverage, lower life expectancy, and varied standards of population health despite an extremely high number of services utilized, as a result of misalignment with need, causing the healthcare system at-large to put resources towards understanding the gaps in the ecosystem.

Research by Humana, has found that preventing early chronic diseases can reduce spending by 34%, eradicating unnecessary services can eliminate 14% of costs, receiving care services at home instead of in hospital facilities can save 30%, and treating unmanaged behavioral health issues can slash costs by 60%.

With current policy trending towards an incentive and penalty rich system, the approach tends to be influenced by local and national politics rather than regional demographic, economic, and environmental trends. But the aforementioned findings prove what we’ve known for years–even Benjamin Franklin famously advised that “an ounce of prevention is worth a pound of cure”.

The key to minimizing these costs while continuing to improve outcomes lies in the social determinants of health. This long-standing pinnacle of public health practice has been increasingly influencing medical practice as healthcare begins to move from volume to value-based care. Shifting the clinical and financial priorities of US healthcare stakeholders towards targeting the social determinants has encouraged a focus on the upstream, long-term drivers of disease, injuries, and other health problems that will result in better allocation of both financial and human resources.

This shift to value-based care has created entirely new sectors in the healthcare field, with both new and existing companies making investments into data analytics, digital technologies, screening programs, and other non-clinical programs to expand what we know about social determinants and encourage the shift from a “sick care system” to a “health care system”. It is also necessary for this fundamental shift to become a cross-industry effort, requiring collaboration between public, private, and state partners to move past the barriers that prevent uniformity in care.

Hospitals and local health organizations are increasingly conducting and reporting on community health needs and using these assessments to influence their own policies and practices. With these health centers taking a bigger role in studying and promoting population statistics, communities are better able to tackle the social determinants of health that limit equal access to care. An added benefit to these strategies occurring at a local level and being part of every day analysis is long-term and fiscally sustainability in the case of unexpected changes at the federal level.

In fact, states with a higher ratio of social-to-healthcare spending from 2000 to 2009 saw better patient outcomes.

The current inhibitors of this goal revolve around a lack of sustainable resource alignment, siloed health services, and poor data integration across sectors. A more unified, collaborative approach to health must be embraced that places value at its core and recognizes the power that social determinants of health play in population health outcomes.  Once resources are aligned, variation in care is addressed, and upstream health factors are prevented, the gap between communities and their corresponding health status will be reduced.