SDOH: Overcoming obstacles to better health outcomes

To effectively support employee health and well-being, business leaders and benefits professionals must think beyond the walls of the workplace. This became a high priority for employers when the pandemic began, and they realized that in order to maintain a healthy workforce, they needed to understand and support the social determinants of health (SDOH) that impact their employees and their ability to manage their healthcare needs.

Understanding how SDOH impacts the workforce continues to be important for employers. A wide range of variables affect how employees manage their health, including access to housing in a neighborhood that is safe and that offers basic community resources, their proximity to healthcare services, access to nutritious food, and their personal beliefs and cultural traditions.

What is SDOH?

The World Health Organization defines SDOH as “the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life.” The Kaiser Family Foundation groups these nonclinical health factors into six broad categories:

• Economic stability
• Neighborhood and physical environment
• Education
• Food
• Community and social context, and
• Healthcare system (insurance coverage and benefits literacy, for example).

Researchers at the University of Wisconsin’s Population Health Institute created a model for measuring and ranking U.S. counties based on health outcomes and contributing factors. While their model attributes as much as 50% of outcomes to a combination of clinical care and lifestyle behaviors, the remaining 50% are attributable to SDOH, including a person’s physical environment, social and economic factors, income and education level, and family and community support. With SDOH having such a significant impact on health outcomes, it is imperative that human resources teams and benefits advisors provide benefits and plan design solutions that include relevant support.

Employee challenges

In a survey of clinical experts who support more than 2 million employee members through thousands of daily interactions, Quantum Health found that SDOH represents a significant and persistent subset of the questions and challenges employees encounter when using health benefits. This informal survey revealed that, in the past 12 months, the individuals who contacted Quantum Health experienced challenges in all SDOH categories identified by Kaiser Family Foundation. The four most frequent challenges were:

• Difficulty with healthcare and benefits literacy.
• Difficulty accessing medical care because of distance or lack of availability.
• Concerns regarding the ability to afford medical care and prescriptions.
• Challenges with accessing behavioral healthcare.

Employees don’t typically disclose these challenges to their employer (nor to their primary care provider), so plan sponsors and providers are often unaware that the challenges exist. However, employers can help by using sensitive approaches to assessing the needs of their population and providing the means for employees to find solutions to address barriers to care. 

Navigation and care coordination

Healthcare navigation and care coordination services can help to identify and proactively address SDOH before they impede care and health outcomes for employees. An effective healthcare navigation solution leverages deep healthcare expertise, data insights, provider relationships and care coordination to address healthcare challenges. For example, in the Quantum Health survey, care coordinators indicated that they regularly address SDOH through:

• Early recognition of intervention opportunities. Using seemingly basic interactions (such as replacing a lost benefits ID card), care coordinators listen for upcoming clinical services for which a member may need support; provide guidance to high-quality, cost-effective providers; and offer resources to assist with resolving SDOH barriers.
• Referral to resources. Care coordinators can refer employees to local community resources and health services. These can include meal assistance programs, chronic condition support groups, financial assistance programs for medications or medical equipment, and referrals to services such as therapy or palliative care.
• Transition of care support. SDOH are an important consideration for an employee’s ability to recover from inpatient care. Poor outcomes, such as readmissions, can result from challenges like insufficient caregiving support, an inability to interpret and follow discharge instructions, or lack of transportation to follow-up appointments. Proactive transition-of-care outreach by skilled nurses can help to identify and address these issues in a manner that leads to better outcomes.

Given the variety and complexity of SDOH variables that can impact an employee’s ability to manage their health, providing effective support will continue to challenge employers and human resources professionals. Fortunately, healthcare navigation can be an effective means for engaging employees in early intervention and problem solving, helping to address gaps in care and support positive health outcomes.