It’s estimated that only 20% of a person’s health status can be explained through a clinical examination—the remaining 80% can be attributed to social determinants of health (SDOH). Decisions that affect people’s health, where people live or work, their level of education and their income play a large role in health outcomes.
When moving toward a health system that prioritizes paying for value vs. paying for services, it’s necessary to capture an accurate depiction of the influences on a person’s health. The shift from quality measurement to quality improvement includes a holistic approach to treatment—and one way to begin that is to ensure that data is collected in a digital format.
All states collect data relevant to SDOH, particularly when it comes to Medicare and Medicaid eligibility and claims, but there’s no commonly accepted standard for how data is captured. The Gravity Project, launched by UC San Francisco’s Social Interventions Research and Evaluation Network, recognized a need for comprehensive coding standards via a consensus-driven approach for SDOH.
The Gravity Project is working to build data standardization guidelines and reduce barriers to exchanging patient risk data related to social and environmental factors. It has focused on 3 of 20 identified domains: food insecurity, housing and access to transportation.
The Need to Address Disparities
Health programs, plans and providers must extend the purview of care to include the nonclinical factors that influence the health of people they manage and treat. Health care costs in the United States can be attributed to a small percentage of the population, and while treatment needs vary by patient, there’s consensus that bridging the gap between health care and other community and social services could drive better health outcomes, from both the clinical and the economic perspective.
Addressing health disparities and championing health equity are key conversations in the health care industry and at NCQA. Not only is access to care and quality treatment essential for positive health outcomes, but addressing the inequities that exist due to SDOH is also integral.
As NCQA continues to develop evidence-based, clinically informed digital measures, the relevance of SDOH cannot be understated. Since NCQA has initiated producing digital measures, the consistency, portability and urgency of efficient health care data has remained a priority and will continue to be an element of future NCQA measures. Consider adopting NCQA’s existing digital measures by joining the Digital Measurement Community to learn more, and browse the 2021 Digital Measures Bundle. The 2022 Digital Measures Bundle are coming soon.