It is well known that COVID-19 can have a greater impact on older adults as well as individuals with pre-existing conditions, but as the current public health crisis continues to evolve, it has brought to light how low-income Americans and minorities are also at risk due to factors related to the social determinates of health (SDoH).[i] SDoH are often defined as the “conditions in the places where people live, learn, work and play,” and these factors can influence one’s ability to meet basic needs, like nutritious food or a safe place to live.[ii] If these needs are not met, they may raise the risk of developing chronic conditions as well as reduce the ability to manage these conditions.
Before the pandemic, SDoH have been a point of interest for both health care payers and providers as a way to improve patient health care outcomes as well as create cost savings and reduce unnecessary utilization of the health care system. SDoH are modifiable factors that influence health, which unlike genetics or natural aging, can be improved to positively impact a patient’s well-being. This pandemic has created an economic crisis as well, causing unemployment claims to exceed 36 million since the pandemic hit the United States, impacting these individuals’ ability to pay their rent or purchase food for their families.[iii] Those already experiencing economic hardship prior to the pandemic may now be experiencing exacerbated hardship due to lost wages and the increased demand on community service providers, further limiting the resources they depend on for support. Furthermore, many community service providers have altered service delivery modes due to social distancing by eliminating walk-ins, requiring appointments, or conducting virtual support. While organizations are doing their best to operate during this time, despite a reduction in charitable giving, canceled spring fundraisers and increased demand for services, changes in operations and programs may impact access to services that now require internet and adequate phone minutes to reach.[iv]
More than ever, SDoH should be addressed to help patients stay as healthy as possible during this pandemic. Social Interventions and Evaluation Network (SIREN) has developed a matrix comparing the most widely used adult and pediatric screening tools for those interested in exploring what is available. These tools address a variety of health and social needs and help guide conversations with patients. They can be administered in a variety of ways – verbally or on paper during the clinical visit, over the phone, by mail or via a patient portal, allowing for flexibility when more providers are transitioning to providing services via telehealth. Screening questions can be integrated into an electronic health record (EHR) for easy administration and data collection. This data can be a powerful tool, not just in understanding the basic needs of patients, but also knowing which needs might be changing or increasing due to unpredictable circumstances such as COVID-19.
Providers and their staff are well-positioned to uncover social needs, as patients already see them as trusted advisors. However, clinicians do not need be social workers or case managers to help. Organizations that specialize in assisting with these needs stand ready to accept referrals and pick up intervention where the limits of the healthcare system end. Additionally, organizations like 2-1-1 provide individuals with a searchable database of local resources available to assist, even during the current public health crisis.
After screening beneficiaries and directing them to appropriate resources or referral agencies, be sure to document any positive findings and diagnosis codes from section Z55-Z65. This is not only helpful for your practice to document but also some commercial payers offer support programs for their beneficiaries to help meet social needs, however, if they are not identified, the payer cannot provide support. These additional benefits could be even more critical for a patient to receive now considering the increased demand community service providers are now experiencing.[v]
While COVID-19 has significantly changed the way the health care system interacts with patients, it has also provided an opportunity to start conversations with patients about the stressors in their lives that could impact their health and link them to resources for support.
[i] https://www.kff.org/disparities-policy/issue-brief/communities-of-color-at-higher-risk-for-health-and-economic-challenges-due-to-covid-19/ [ii] https://www.cdc.gov/socialdeterminants/ [iii] https://www.pilotonline.com/business/jobs/vp-nw-unemployment-virginia-20200423-7ufle7b4rjh3rjy24alrkc2wku-story.html [iv] https://www.healthaffairs.org/do/10.1377/hblog20200413.886531/full/ [v] https://hqin.org/news/the-importance-of-documenting-and-coding-social-determinants-of-health/?utm_source=RVA+Community+Cares+Newsletter&utm_campaign=e21811ca9c-EMAIL_CAMPAIGN_2019_02_25_09_47_COPY_01&utm_medium=email&utm_term=0_ac4071392a-e21811ca9c-74257748