Financial Incentives Biggest Barrier to Social Determinants of Health

November 16, 2020 - The success of social determinants of health strategies is contingent on funding and supportive financial incentives, providers revealed in Insights by Xtelligent Healthcare Media’s latest report.

Recent work has shown sizable investments from healthcare organizations to address these non-clinical factors influencing patient health, including over $1.6 billion in housing-focused interventions and $294.2 million to address food insecurity.

And over half (54 percent) of respondents to Insight’s work said their organization is currently implementing social determinants of health strategies. Another 12 percent are not but are building initiatives to address these factors in its patient populations.

Among those organizations that are not rolling out social determinants of health programs and have no plans to do so, 34 percent said the biggest barrier was a lack of reimbursement.

Even those organizations with social determinants of health initiatives are concerned about funding.

“The funding is questionable, but it has worked for us. There will come a time when we’re just not able to go on,” an administrator at a free clinic reported during qualitative follow-up. “In another five years or so, if we don’t change the way we’re doing things, we are going to be out of business.”

Her organization relies almost exclusively on charitable donations for funding. Without philanthropy the clinic would almost certainly have to close its doors and be unable to support patients without insurance.

Nearly half (43 percent) of organizations reflect a similar sentiment and rely on philanthropy to fund social determinants of health strategies. And only ten percent of respondents are very confident in the sustainability of their funding streams.

Sustainable funding methods are critical if social determinants of health initiatives are to thrive. From upfront costs of initiation to continued community partnerships, finances play a crucial role. In fact, 58 percent of respondents site funding to support partners as the biggest challenge to successful community partnerships.

Improved and sustainable funding would help overcome these challenges, but that begins with data.

“If you get enough data, we will start considering social determinants of health in reimbursement,” one nurse pointed out. “There has to be a concerted effort to make sure that all case managers, all social workers, are systematically documenting this stuff.”

Once information is more regularly captured in the EHR, social determinants of health codes can be taken as seriously as traditional clinical codes. When a provider notes a patient is experiencing homelessness, similar steps to reimbursement will be taken as if the provider had documented the patient having diabetes.

So many provider organizations believe sustainable funding lies in incorporating incentives into existing payments structures. Thirty-eight percent of respondents say value-based contracting is the most sustainable way to support social determinants of health initiatives and another 20 percent believe fee-for-service arrangements are the most sustainable.

Regardless of the specific reimbursement model, each of these methods builds funding for social determinants of health into existing payment structures. Organizations would not have to rely on philanthropy and the generosity of donors to address patient needs if addressing social determinants of health were financed in the same way other health challenges are.

Future work and collaboration should promote integrating social determinants of health screening and programs into existing payment structures in order to have the best and most sustainable impact on patient health outcomes.

Social Determinants of Health Strategies and Initiatives also highlights hospital, health system, and physician practice motivation for social determinants of health strategies and outcomes hospitals and physician groups are focusing on to understand success in social determinants of health initiatives. The full report can be found here.