Improving Value

Social Determinants of Health Screening Tools

Healthcare providers are trained to identify patients’ medical needs, but unmet social needs contributing to poor health outcomes may be more difficult to detect. Social determinant of health screening tools can help providers surface patients’ health-related social needs in order to connect them to social supports.

A 2019 analysis from AmeriHealth Caritas revealed that social determinants of health screenings, accompanied by interventions to address social needs, reduced hospitalizations for the organization’s high-risk Medicaid patients by nearly 30 percent.¹ The average length of time that patients spent in the hospital after an inpatient admission also decreased, by 27 percent. Other benefits included a 10 percent reduction in emergency department visits, 22 percent reduction in potentially preventable admissions and 12 percent reduction in potentially avoidable emergency department visits.

Currently, there is no consensus on the best method to screen for social needs. Providers use a diversity of screening tools with varying levels of success. Best practices, as identified by Health Leads,² include:

• Making questionnaires short and simple to ensure that patients understand the questions and answer them fully;
• Avoiding broad questions that may generate false positives, narrow questions that don’t catch enough patients or questions that are relevant to only specific patient demographics (e.g., pediatric or senior populations);
• Integrating the screenings into clinical workflows; and
• Asking patients to prioritize their unmet needs and identify their goals and strengths to clarify the best supports to provide.  

Providers should also be educated on how best to approach these conversations, as patients may perceive the questions to be invasive or discriminatory if they have not developed a trusted relationship with the asking provider. Finally, screening efforts should be coordinated across providers to avoid repeatedly asking patients to divulge sensitive information.

 

Notes

1. "AmeriHealth Caritas' Inclusion of Community Health-Based Services Reduces Emergency Room Utilization," AmeriHealth Caritas (July 11, 2019). 

2. "The Health Leads Screening Toolkit," Health Leads (September 17, 2018). 

More on this Topic

• Healthcare Value Hub: Consumer-Focused Health System Transformation: What are the Policy Priorities? (March 2019). 
• JAMA Network Open: Prevalence of Screening for Food Insecurity, Housing Instability, Utility Needs, Transportation Needs and Interpersonal Violence by US Physician Practices and Hospitals (September 18, 2019). 
• Journal of General Internal Medicine: Impact of Social Needs Navigation on Utilization Among High Utilizers in a Large Integrated Health System: a Quasi-Experimental Study (June 21, 2019). 
• Public Agenda & United Hospital Fund: It's About Trust: Low-Income Parents' Perspectives on How Pediatricians Can Screen for Social Determinants of Health (June 2019). 
• National Alliance to Impact the Social Determinants of Health: Identifying Social Risk and Needs in Recommendations for Continued Exploration (January 2019).