Despite widespread knowledge about the impact of social determinants of health – such as housing and food insecurity – the U.S. health care system does a poor job of taking those factors into account when caring for patients, the co-founders of The Health Initiative, a Boston nonprofit, told physicians at the Texas Medical Association's Fall Conference on Saturday.
TMA is poised to lead the U.S. medical community toward a more constructive approach to these important factors in shaping health, they said.
"It's in a position to do two things," Rebecca Onie (Pictured above), one of the co-founders, told Texas Medicine Today after the presentation. "One is to authoritatively advocate for inclusion of drivers of health quality measures and financial incentives. Also, advocate for public and private investments in that resource landscape."
TMA already is headed in that direction, she says. In May 2019, the TMA House of Delegates approved Resolution 316, which called on TMA to:
- Study social determinants to better understand their impact on medicine;
- Advocate to government and commercial payers the impact of social determinants on health care quality and costs; and
- Advocate that those same payers modify performance and quality programs to include determinants of health in compensation for government services.
Research done by The Health Initiative shows that both patients and physicians seem to understand intuitively the importance of social determinants in maintaining good health, Ms. Onie said during the presentation, "State-Level Leadership on Drivers of Health." Yet the quality metrics on which physicians are evaluated and paid by insurers do little or nothing to take social determinants into account.
In 2017, The Health Initiative held a series of focus groups across the country that asked people: "If you had $100 to buy health in your community, how would you spend it?" said Ms. Onie, a 2009 MacArthur Fellow and member of the National Academy of Medicine.
Regardless of background, people consistently chose to invest more resources on social determinants rather than direct health care, Ms. Onie says. African-American Democrats in Cleveland reached the same conclusions as white Republicans in Dallas and Latino swing voters in Seattle, she says.
"All of the focus group chose to spend more money on access to food and safe, affordable housing than on hospitals and clinics," Ms. Onie said. "That notion that we might just agree on what drives health is a pretty powerful one."
Her group found similar unanimity across demographic factors and belief systems when it gave the same question to physicians in North Carolina in 2019, Ms. Onie says.
Co-founder Rocco Perla, a former official at the Centers for Medicare & Medicaid Services, said ignoring social determinants produces more sick people and creates costs that physicians have to bear. He pointed to data showing that as the number of food deserts increases in a geographic region of Texas, so do the health care costs of malnutrition.
"This is a financial risk to insurance companies," he said. "But it's also a risk physicians have to absorb every day, but it goes totally unaccounted for. It's not in any of the quality measures of financial incentives. You will get risk stratified for your diabetic patients, but a diabetic who lives in a food desert or is food insecure doesn't count, even though we know those patients are going to cost more."