Government Support for Social Determinants of Health (SDOH) Programs

May 21, 2024

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Government involvement in supporting Social Determinants of Health (SDOH) initiatives in the United States healthcare system reflects an increasing recognition of the importance of addressing disparities and promoting health equity.

Healthy People Initiative

One prominent national  example is the Healthy People initiative, led by the U.S. Department of Health and Human Services (HHS). Healthy People 2030, the latest iteration of this initiative, focuses on SDOH, health equity, and health literacy, proving the importance of SDOH in the future of healthcare.  These national objectives set forth by Healthy People serve as a guiding principle for new measures, programs, and research. 

CMS IQR | The Hospital Commitment to Health Equity Measure

Starting in the 2020s, government mandates have further propelled SDOH initiatives within the healthcare system. For instance, the Centers for Medicare & Medicaid Services (CMS) have introduced measures like the Hospital Commitment to Health Equity, aimed at encouraging hospitals to prioritize equitable care. The aim of the Hospital Commitment to Health Equity measure isn’t to assess care equity directly; it’s to gauge if an organization prioritizes health equity strategically. It comprises five domains, each worth one point, totaling five possible points. However, to earn a point in each domain, an organization must affirmatively attest to all elements. Additionally, CMS plans to publicly report scores, providing further motivation for compliance.

diverse population in a medical office waiting room

CMS IQR | SDOH-1 and SDOH-2

CMS mandates hospitals to implement screening measures for social drivers of health (SDOH-1 and SDOH-2), which will be required for hospitals in 2024 under the IQR program. These measures, initially voluntary in 2023, verifies if a hospital collects SDOH information, and if so, what percentage of the population screen positively. Screening for Social Drivers of Health (SDOH-1) assesses whether hospitals screen patients aged 18 or older upon admission for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety. Then, the Screen Positive Rate for Social Drivers of Health (SDOH-2)  measures the percentage of patients screened for social risk factors who test positive for one or more of these factors, including food insecurity, housing instability, transportation problems, utility difficulties, or interpersonal safety.

CMS offers flexibility in how hospitals conduct this screening, allowing for the use of self-selected screening tools–however, they suggest using the AHC Health-Related Social Needs Screening Tool.

people in a clinic waiting room

Office of the National Coordinator for Health Information Technology (ONC)

Outside of CMS, government agencies like the Office of the National Coordinator for Health Information Technology (ONC) have integrated SDOH considerations into health data interoperability standards. SDOH data, mandated in Version 2 of the United States Core Data for Interoperability, are essential for capturing patients’ holistic health information.  A huge driver in integration of SDOH information within existing electronic health records (EHR) is The Sync for Social Needs coalition, comprising entities like the National Committee for Quality Assurance, The Joint Commission, and the National Quality Forum. The coalition aims to standardize the exchange of SDOH data across health records using interoperable technologies like Fast Healthcare Interoperability Resources (FHIR®).

Conclusion

In conclusion, government initiatives like Healthy People 2030, CMS mandates, and ONC’s interoperability standards are crucial steps toward integrating Social Determinants of Health into the U.S. healthcare system. These efforts not only highlight the importance of addressing social disparities but also promote strategic prioritization of health equity across hospitals. By mandating screenings and standardizing data exchange, these policies aim to ensure that healthcare providers can better understand and address the holistic needs of their patients, ultimately leading to improved health outcomes and a more equitable healthcare landscape.

 

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