VCU Health System (VCUHS) systematically screened patients for health-related social needs to identify and address factors outside of the clinical setting that impact patients’ health. Screening for social drivers of health (SDOH) is still relatively new for many health care providers but VCUHS committed to this practice at the beginning of a pilot model and continued the work beyond the trial end date.

VCUHS used the Accountable Health Communities Health-Related Social Needs Screening Tool as part of its program that focused on Richmond-area (Virginia) Medicaid and Medicare beneficiaries for five core needs: food, housing, utilities, transportation and safety. It became one part of several programs VCUHS is currently implementing to address their patients’ needs and inequities in health outcomes.

The COVID-19 pandemic increased stress on available staff, but it also heightened the awareness of health inequities and the impact of social drivers in the community. The pandemic prompted VCUHS to shape the most efficient ways to offer screenings and provide resources, ultimately prioritizing screening using full-time staff. They established remote screening workflows as well as expanded screenings into new clinical environments.

In partnership with Health Quality Innovators, VCUHS offered 21,000 screenings and provided navigation services to over 2,000 patients, resolving more than 2,400 needs for those patients. VCUHS believes their work now has them positioned to meet requirements beginning this year (2023) from both the Joint Commission and the Centers for Medicare & Medicaid Services (CMS) for screening and addressing social needs as well as demonstrating a commitment to health equity.

VCU Health System is a 2022 Health Quality Innovator of Year runner up in the Health Equity Category. Click HERE to read about all of the winners and runners up.