How the Best Hospitals Manage Social Determinants of Health
May 29, 2015 | Jane Stuckey
The Cleveland, Ohio VAMC manages the care of 110,124 veterans, but it provides more than healthcare. It impacts upstream determinants of health such as employment and housing. The VA leads a robust homeless outreach program. It also operates a resource center for veterans transitioning out of homelessness and unemployment.
As a way to meet the needs of chronic care patients, the VA offers a home telehealth program that served 10,000 visits in 2014. The program saved an average of $2,000 per patient per year, and reduced ED visits by 22%.
Frequent ED visits suggest that something is not working in the patient’s life and it may not relate to the treatment at hand. While one would expect remote blood sugar and heart rate monitoring to work well, that the success of the program stemmed unexpectedly from the daily nurse calls. Social interaction with nurses on nutrition and emotional health made the greatest difference in patient outcomes.
As architects, we may start to develop new types of “social telehealth” spaces for as the caregiving model evolves.
“When life goes wrong, health goes wrong”
At the Cleveland Clinic Patient Experience Summit, Alexandra Drane described the Eliza Vulnerability Index. The index measures life-context variables that affect health outcomes. Financial stress, workplace stress, relationship problems, one’s sex life, and the demands of being a caregiver cause the greatest burden on health.
High-vulnerability patients incur $4,000 more in insurance claims per year than low-vulnerability patients. They required three times as many prescription medications and were more likely to log a hospital visit. Researchers also found that vulnerability predicts which individuals fall among the top 5 percent in healthcare spending.
Medicaid patients scored the highest rates of vulnerability. Yet, vulnerability mapped to worse outcomes at every income level. This diverges from the premise that income is a predictive factor in patient health. 94% of people in all income categories report problems with at least one variable, and 40% struggle with four or more.
We can infer that traditional patient outreach or may not translate to taking charge of one’s health. Proactive healthcare requires individuals to operate at the top of Maslow’s hierarchy of need, but sometimes priorities are much more basic. Better access to health information or education isn’t always the issue, as described by Debbi Heffern.
At AONE, the Medical Center Health System in Texas shared their “lessons learned” from a risk stratification tool. The tool uses nurse assessments to predict the likelihood of a patient readmission. The intent of the program is to address the issues surrounding the patient that impact their risk of returning to the hospital.
Transition nurses determine whether the patient needs home social work visits, Meals on Wheels, weekly phone calls, and so forth. High-risk patients have ongoing access to a call system for emerging health questions.
The hospital foundation also participated in the program. It helped patients sign up and pay for health insurance, and provided copay vouchers for primary care visits. And, it secured grants for home monitoring equipment.
How does your organization manage the social determinants of health? Share your experience in the comments section below.
ABOUT THE AUTHOR Jane Stuckey RN, BSN, MS, FACHE
Drawing upon experience as a COO in both non-profit and for-profit healthcare systems and Director of Clinical Affairs for a major insurance company, Jane recommends strategies that result in improved patient, staff, and physician satisfaction, operational efficiency, and financial strength. Read more from Jane.
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