According to RJ Briscione, director of the focus group, addressing the social determinants of health (SDH) requires several essential elements: having reliable and up-to-date data on people’s social needs; being out in the field and talking to people face to face; and the ability to adapt and make changes.
Briscione guided a panel of experts on how addressing these social needs affects health equity at last month’s conference 2022 State of Oregon Reform Health Policy Conference. Joining him on the panel are Jess Soltesz, director of social health at Kaiser Permanente Northwest, and Richard Bruno, MD, senior medical director of clinical care at Central City Concern, a homeless-serving organization in Portland.
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The roundtable had a common theme throughout: data. Advocates in the health sector have long identified stronger and more coordinated health data collection as paramount to effectively manage SDST. The panelists doubled down on this.
“How do we collect this data and how do we make sure we reach the people who really need it, and not just the people we see coming into our clinics on a daily basis? said Soltesz.
Soltesz noted that there are “hidden populations” that current SDOH outreach strategies are not reaching, leaving the sector with incomplete data on their social needs. Since people with SDOH issues tend to access the healthcare system at lower rates, she said, it is essential that the healthcare system conducts proactive and intentional outreach to individuals.
“Unless we specifically target these populations, we won’t have a good idea of the real needs,” she said.
A big part of that is incorporating more community-centric methods of intervention, like non-English data collection options and community health workers. She said community health workers need to be involved for longer durations to get to the root of people’s social needs.
” In our world, [SDOH are] won’t show up before [patients] show up with some sort of high need in our medical system,” Briscione said. “It’s the only way we have to measure things, unfortunately.”
Soltesz stressed that the health system does not need to create a new structure to collect social data, but rather needs to partner with community organizations (CBOs) that are already doing this work and leverage the data they receive. on beneficiaries to implement SDS interventions.
“We can’t just ask to ask, we have to ask for a reason,” Soltesz said of the SDOH data collection.
Discussing how COVID has affected data collection efforts, Briscione and Soltesz highlighted the digital divide as a major hurdle. When organizations rely on e-outreach methods to identify social needs, only those who have the ability to access the necessary technology or are technologically savvy can engage. They are often “rich white people”, Briscione pointed out.
For example, when Briscione was facilitating the distribution of COVID vaccines while working for Aetna, his team selected vaccine retailers close to the greatest number of black and brown residents to target these underserved populations and ensure that they had access to vaccines.
However, he found that the only people signing up for appointments were those who had the technology to be able to book vaccination appointments online, not the targeted underserved populations.
To improve this, Briscione and his team instead distributed vaccines through trusted community organizations that served those communities, such as black churches. His team also purchased vehicles to carry out mobile vaccine distribution, rather than relying on the online registration process.
Soltesz added that it is important to go to the communities and learn directly from them how best to carry out projects like the distribution of vaccines, rather than present a pre-established plan to the communities without having consulted its members
The panel also emphasized that data collection is only one piece of the puzzle; the data must also be synthesized and used in a meaningful way. Bruno pointed out that there are many ways to accumulate data on SDOH— community health needs assessments, providers directly interviewing patients, payers interviewing beneficiaries — but there aren’t many effective ways to share them and use them to effect change.
This, he said, provides an opportunity for collaboration between the different organizations collecting the data. He urged stakeholders to stay abreast of the SDOH data that continually emerges from the pandemic and think about ways to use this data to create collaborative solutions.
Panelists also cited some recent examples of successful SDOH-focused initiatives in Oregon.
Bruno spoke about how critical housing has been during COVID and how providing housing assistance can help protect Oregonians from the risks of overcrowding during public health emergencies like COVID. He listed the city of Portland’s Safe rest villages initiative as an effective way for the government to address the housing shortage for the thousands homeless in Portland as a result of COVID.
Through this project, the city implemented a “module system” in which it separated areas, or “modules,” for homeless people that contained essentials like heating and accommodation. This allowed these individuals to maintain social distancing practices while maintaining access to essentials.
Briscione and Soltesz discussed Health Share Oregon’s successful efforts to use data to reach members who may be at risk for heat or climate-related health impacts and offer them Medicaid-covered air conditioners. Health Share Oregon reached out to members who had a history of respiratory illnesses, etc., and ended up distributing about 300 air conditioning units to Medicaid recipients who needed them during this summer’s heat wave.
Briscione also discussed Aetna’s partnership with Feeding South Florida, which has created school pantries for food-insecure families to receive groceries. They also proposed a survey in Spanish on the social needs of beneficiaries who have committed to the program.
Once his team identified that transportation was an unresolved issue for these families (many families had limited access to transportation to pick up food and/or bring it home), they set up “ mobile “farms” through which vehicles brought food to a network of clinics closer to families in need.
Briscione said this project significantly reduced the A1C levels of the target population.
“I think it comes down to this model: start with something, find a good partner, you’ll have to adapt and know what you want to measure, and keep going,” he said.
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