Helping patients who are both medically and socially complex challenges a lot of U.S. health care organizations. Many doctors say, “I didn’t go to medical school to learn how to handle social issues.” But while providing quality medical care is part of what creates good health outcomes, we know that the social determinants of health (SDOH) play a big role in terms of the ultimate outcome.
Social determinants of health are complex issues, and Kimberlydawn Wisdom points to the skilled, license professionals, such as social workers, who help address these issues. How can physicians move into that space? Wisdom, who is Chief Wellness and Diversity Officer and Senior Vice President for Community Health and Equity at Henry Ford Health System, asks Sanjay Saint, Chief of Medicine for the VA Ann Arbor Healthcare System, and Frederick Cerise, President and CEO for safety-net Parkland Health and Hospital System, how each of their health systems tackles the challenges around addressing social determinants, whether that’s insecurity around food, housing, transportation, or other concerns.
“The VA faces those types of issues, of course, especially veterans who have mental illness or have substance use issues,” says Saint. “One of the things that became a priority almost a decade ago was to end homelessness among veterans.”
The U.S. Department of Veterans Affairs partnered with the Department of Housing and Urban Development on this effort. “We’ve invested a lot in that; it’s decreased by about 45%. But on any given day, about 40,000 veterans are still homeless in this country,” says Saint. He describes their multipronged approach, which includes social work, temporary housing, longer-term housing for veterans and their families, employment opportunities and training, primary care visits where the doctor goes to the patient, dental care, and domiciliaries for veterans who don’t have other places to live.
Wisdom points to Boston Medical Center and Bon Secours in Baltimore as health care organizations that are also working to address the housing needs of their patients. “There’s a lot that we can learn from even systems that may have constraints in terms of how we can address social determinants,” she says.
“We [Parkland] are a constrained system — we don’t have unlimited resources — but health care has a lot of resources,” adds Cerise. “When I talk to my colleagues who are in homeless shelters or in food banks or things like that, the magnitude of constraint is a lot different.”
Cerise describes a pilot Parkland conducted with homeless shelters and food banks to see if they could share information back and forth and if that sharing of information, for people who were discharged, could result in a reduction in readmissions. If they were successful, they would give money to the shelter or food bank they’d shared information with — “a big deal to that community-based organization but to a billion-dollar health care organization, less of a big deal.” That pilot transformed into Parkland’s Accountable Health Communities work, where they now screen for social determinants: food insecurity, trouble with utilities, housing, transportation, etc. When patients are interfacing at a Parkland facility, they’ll do that screen, and with the electronic shared interface, referrals can now be made to over 100 community-based organizations.
From the NEJM Catalyst event Essentials of High-Performing Organizations, held at the University of Michigan’s Institute for Healthcare Policy and Innovation, July 25, 2018.