Doctors say social determinants matter to patient health, but not their responsibility

While doctors know that factors such as patients having access to nutritious food and affordable housing makes a difference to health, many don’t think it’s their role to help patients when it comes to those needs, according to a national survey by D.C.-based consulting group Leavitt Partners.

Most physician practices do not have access to resources that would allow them to help address patients’ social needs, said David Muhlestein, Ph.D., chief research officer for Leavitt Partners and one of the report authors in an interview with FierceHealthcare.

The report was based on a national survey of 621 physicians.

The results of the survey found answers did vary a bit based on the doctors' own demographics and who they generally treated.

Younger physicians are more likely to recognize the need to address those kinds of factors, he said. For instance, the survey found that physicians who have been practicing fewer than 20 years are significantly more likely to believe that assistance to help increase income and assistance arranging transportation would benefit their patients to a great or moderate extent compared to doctors who have been practicing for 20 years or more.

RELATED: New Blue Cross Blue Shield Association initiative takes aim at social determinants of health 

David Muhlestein
David Muhlestein (Leavitt Partners)

Physicians working with poorer patients were also more likely to believe they would benefit from various kinds of help. Physicians with 30% or more of their patients on Medicaid were significantly more likely to believe their patients would benefit from help getting affordable housing, increasing income and arranging transportation.

What kinds of help would benefit patients? Almost 75% of surveyed doctors said patients would benefit to a great or moderate extent from information about the price of care and about health insurance, including enrolling in public insurance plans. Some 54% said help increasing patient income would be of assistance; 48% said getting sufficient food and 45% said help with affordable housing would benefit patients.

RELATED: To really improve patients’ health, address poverty and other social needs, physician group says

Not surprisingly, two-thirds of doctors (66%) believe that assistance arranging transportation for healthcare would help patients. That high percentage reflects the fact that physicians see the results when patients miss appointments and don’t have access to care, Muhlestein said.

Patient no-shows, which hurt revenue and create scheduling gaps, are a major frustration for physician practices. Healthcare organizations have been experimenting with using ride-hailing services such as Uber and Lyft to solve the problem, offering their patients a convenient, low-cost way to get to their appointments.

But it’s a complicated problem, and one study found giving Medicaid patients a free ride to the doctor’s office didn’t reduce the rate of missed doctor appointments.

RELATED: Free rides don't solve the problem of missed doctor appointments, one study finds

The effect of other social determinants, such as food and housing, may not be as apparent to doctors, Muhlestein said. However, one thing that is foreseeable is that someone working an hourly job may lose income if they miss work to go to a doctor’s appointment. While the appointment may be free if the person is on Medicaid, the cost is not free if the person pays a price in their paycheck.

When it comes to who is responsible for social determinants of health, most doctors think they or insurers are not responsible for needs such as food and housing. Many feel powerless as individuals and say it is someone outside their own office or practice who is best positioned to help.

That may begin to change as value-based payment models come into play, Muhlestein said. Value-based models may cause physicians to think about social determinants in a different way. Those models will increasingly require doctors to pay attention to more than clinical excellence to include nonmedical social determinants, the report found.

If value-based models pay doctors based on the health and well-being of patients, that may move the needle, he said. If providing access to social services will improve patient health, it may motivate doctors to take responsibility. If they don’t address social needs it will lead to higher medical expenses, which will count against a practice in a risk-bearing system.

It may benefit a practice, for instance, to hire a social worker if the total effect is going to be better patient health and outcomes, he said.

Given the fierce national debate on healthcare, the national physicians group The Physicians Foundation said now is the time to address patient issues that go beyond good medical care, including poverty and other social needs that impact health.