Healthcare providers need to work more closely with governments and community organizations to better address the social determinants of health, according to a report released Monday by the National Academy of National Academies of Sciences, Engineering, and Medicine.
Providers must also more rigorously educate themselves and think critically about the potential root causes of poor health, and ultimately the factors that lead to suboptimal patient outcomes.
“Everyone involved in the health arena has a role,” the new framework states. “The social determinants of health can and should be integral to all health professional education and training.”
The report is the second of five commissioned by HHS. Federal officials asked the National Academies to examine how health is affected by social determinants—such as race, gender and socio-economic status. The analysis is an important one amid the growing number of payment reform strategies. While these programs offer financial rewards and penalties to health providers for their performance on quality metrics, some have said the metrics are flawed.
The first report of the series was released in January. It said that there is no question social determinants influence a patient's healthcare access, cost and outcomes. However, understanding which factors are within a provider's control and how to adjust for them in value-based payments remains fuzzy.
Critics have argued that it's unfair to use metrics that do not adjust for communities with higher populations of poor patients. Those patients may not be able to afford follow-up treatments or may have limited access to resources, such as healthy foods or therapy that lead to better outcomes.
However, the CMS has said hospitals can overcome challenges posed by certain patient populations. In January, the federal health insurer released a guide to help hospitals curb readmission rates among ethnically diverse patients.
“It's really about stretching beyond what would be considered the normal bounds of the hospital to be effective,” said Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association.
The AHA recently highlighted a program by a system in Pennsylvania where medical students volunteer to help identify patients with transportation or childcare concerns, which may cause those patients to skip appointments.
Not only does it provide help to patients who need continuing care post-hospitalization, but it benefits future healthcare professionals by making them aware of real challenges that impact patient adherence to clinician recommendations. “Which is, in my mind, very laudable,” Foster said.
The new framework from the National Academies includes four recommendations. They encourage use of “transformative techniques” through medical school curriculums, continuing education programs for healthcare professionals and community partnerships. The goal is to create “lifelong learners” about social determinants, but it also requires “the movement of knowledge into action,” according to the report.
“Health professionals must develop appropriate skills and attitudes to be advocates for change.”