RWJBarnabas launching 'universal' social determinants of health screening

Every single patient that heads to a RWJBarnabas Health facility will be soon be screened for social determinants of health and, if needed, referred to services for ongoing support, officials announced Tuesday.

SDOHs are social or environmental factors in a patient's life—such as their access to healthy food, safe housing or transportation—that can ultimately impact their health. 

Officials from the New Jersey-based health system say the program, called Health Beyond the Hospital (HBTH), will be the first "end-to-end, universally applied, culturally-tailored and fully integrated" SDOH program in the country. 

“What defines our health is so much greater than genetics or clinical care; 80% of all health outcomes are due to social, behavioral, and environmental factors that are the social determinants of health,” said Barry Ostrowsky, president and CEO of RWJBarnabas Health, in a statement. "The timely interventions made possible by Health Beyond the Hospital will create a spiral that will positively impact the well-being of our patients and all of those caring for patients across our community.”

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To establish the offering, RWJBarnabas partnered with personalized digital community referral platform NowPow and patient engagement platform ConsejoSano. Care providers will be able to use the technology from both partners to tailor a recommendation of resources a patient needs and "e-prescribe" those resources, connecting them directly to support such as the federal Supplemental Nutrition Assistance Program program.

The HBTH program is an example of a growing number of health system investments in programs targeting areas such as housing or employment insecurity. A study in Health Affairs estimates SDOH programs accounted for at least $2.5 billion of direct annual investment by health systems, the bulk of which focused on housing insecurity ($1.6 billion) and employment ($1.1 billion). The remainder was spread across areas including education, food security, social and community context and transportation.

For example, Kaiser Permanente said it would put $200 million toward initiatives targeting housing insecurity and homelessness. Geisinger is scaling up what it calls its Fresh Food Farmacy program—set up to help patients get healthy foods—with a digital app.

Last year, RWJBarnabas Health partnered with Horizon Blue Cross Blue Shield of New Jersey to address social factors of health such as maternal mortality.

Health systems often target their SDOH efforts on patients with the lowest incomes or who are frequent utilizers of the healthcare system, DeAnna Minus-Vincent, corporate senior vice president of social impact & community investment at RWJBarnabas Health, told Fierce Healthcare.

"Our questions focus on not just whether someone can afford food, but also on good nutrition. 'Are you eating fruits and vegetables? How many sugary drinks do you have a day?'" Minus-Vincent said. They also ask questions around social isolation, substance use, intimate partner violence and housing needs such as rodent infestations or mold, she said. The program is built to allow patients to answer questions from the privacy of their mobile device or in a conversation with a medical professional, depending on how they feel most comfortable.

To start, the program will be piloted first within select RWJBarnabas sites and will screen all patients for factors such as food security, access to housing, educational opportunities, smoking and substance use and transportation. Officials said they are intend to tuck SDOH screening into the clinical process through the electronic health record in the same way vitals like temperature, weight or blood pressure are checked.

The program will be phased in across each of RWJBarnabas facilities by the end of 2021.

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It was launched with $3 million in backing from the Walmart Foundation and the Robert Wood Johnson Foundation.

That funding is being used for for the planning and piloting of the program, as well as helping cover the increased costs that may be incurred by community partners as patients are connected for services, Minus-Vincent said. For instance, the heath system expects more demand for community programs that help individuals access food. It is also putting money into building food hubs to strengthen the food ecosystem, she said.

There could be an uptick in costs for the health system in the short-term, Minus-Vincent acknowledged.

"We think that, in keeping people healthier, in the long-term it helps everyone," she said. "With financial structures the way they are now, with the reimbursement structure, some may say that hospital systems may not win but I think at RWJBarnabas Health, if our patients are healthier, they do win."

The health system doesn't want that just to be a theoretical idea, but is planning to put data behind it, she said. "We are going to ensure that, during this process, we are building evidence to capture diagnosis codes for social determinants which currently are not reimbursable by payers, both government payers or commercial payers. But they will never be reimbursable if no healthcare systems are building the evidence and capturing those."