Study dives into patients' views on the social determinants of health and what that means for payers, providers

Individuals who are living with chronic or acute conditions have a much different view of the social determinants of health (SDOH) compared with researchers and the media, according to a new study (PDF) out of the Anthem Public Policy Institute.

Individuals are focused on daily influences such as finding the right doctor and nutritional food, while researchers focus on more structural factors such as education and income level, according to the report. Partnered with Quid, the report made these determinations by examining the conversations in news articles and academic papers along with patient forums focused on cancer, diabetes and mental health conditions.

“By better understanding how individuals view and talk about social determinants, payers and providers alike can identify new and improved ways to engage with them to more effectively improve their health and well-being and the delivery of healthcare,” Jennifer Kowalski, vice president of the Anthem Public Policy Institute, said in a statement.

Plus, she noted that individuals were more focused on food and social support, which could be more easily modified by payers and providers than big trends such as economic stability and education.

Looking at social media, the factors most discussed on patient forums for cancer and mental health conditions were social support and navigating the healthcare system. And food and nutrition were the most common posts on forums for patients with diabetes.

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The biggest factors for individuals included navigating the healthcare system, 44%; social support, 25%; food, 12%; economic stability, 10%; neighborhood, 5%; and education, 4%. These concerns seemed to widely differ from those of the media and researchers, which came out with economic stability almost as important as education, 20% and 22%, respectively. Almost a three-way tie for the next set of concerns included navigating the healthcare system, social support and neighborhood, 17%, 16% and 16%. Food only accounted for 9% of the overall concerns.

Social support was a dominating part of the individual discussions around SDOH comprising 25% of all conversations, but only 11% of academic papers. And these individual posts—both positive and negative—were highly shared on social media. Those in diabetes and cancer forums reported a lot of positive support from family members, while those living with mental health conditions were less likely to be receiving social support. In fact, only 20% of all posts on social support for those with mental health conditions were positive.

Almost half of the forum posts by individuals with mental health conditions and cancer were around access to providers and care. The posts were just about split between positive and negative reactions to finding providers. The study notes that none of the posts raised the issue of access to linguistically appropriate care, yet 12% of academic and media narrative did focus on this concern.

So why such a discrepancy in focus between patients and academics?

"One possible hypothesis is that individuals are focused on those social factors that they can more easily modify—such as finding the right provider or eating healthy—and the impacts they can recognize on a day-to-day basis," Kowalski told FierceHealthcare. "It follows that these are the same issues that individuals might bring up in online patient forums as well. In contrast, academics tend to focus on those things that are measurable with data, and therefore structural factors like income and education level are more easily studied. In turn, the findings from academic studies make up a portion of the media coverage on social determinants of health, along with notable new initiatives, such as local investment in new low-income housing solutions."

The report does see opportunities to bridge the gaps between individuals and the public view of SDOH. In fact, it states that increased spending to address intermediary factors like food security and housing stability improves health.

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Plus, many of the discussions had overlapping challenges; for example, lack of social support could be related to access to transportation, and anxiety could also play a part for those with mental health issues.

The paper also suggests that payers and providers invest in access to food, transportation and social capital. Another suggestion is to integrate clinical and social data and models of care to develop targeted interventions. And finally, to support policy and funding that expand available solutions

"A good first step is for payers to engage in their communities—build partnerships, support community organizations that address social needs, and expand their own capacity to identify and address social needs among members," Kowalski said. "This will benefit members as well as their communities broadly. From there, health plans—especially in the Medicaid and Medicare Advantage programs—have more flexibility now than at any time before to address SDOH through benefit design, models of care, and other interventions."