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APPLYING SOCIAL DETERMINANTS OF HEALTH DATA





APPLYING SOCIAL DETERMINANTS OF HEALTH DATA

JENNIFER JONES, MSM RD

September 28, 2021


At Springbuk, some of the most common questions we are asked have to do with why
certain groups have low levels of engagement, more gaps in care than their
general population, and how to ensure that the right programs are in place for
the right populations. While it sounds simple, the reason is not all groups are
the same. More recently, employers are being challenged to address Social
Determinants of Health as a way to address access and outcomes for members and
the impact of health benefits and programs.

Based on this year’s Healthiest Employers data, only 45.2% of applicants
indicated that they are analyzing social determinants of health (SDOH) when
evaluating their benefits and wellness programs.

The CDC identifies five main components of SDOH: 

 * Healthcare Access and Quality
 * Education Access and Quality
 * Social and Community Context
 * Economic Stability
 * Neighborhood and Built Environment

Recently, I had the opportunity to sit down with three leaders in employee
wellness who all utilize SDOH within their organizations – Jesse Gavin, Senior
Wellness Manager at Baylor College of Medicine, Jeanette Martin, Vice President
& Employee Wellness Manager at BankUnited, and Erica Miller, Vice President of
Healthcare Strategies with Duley, Bolwar, and Pederson. 

Below are key takeaways from the conversation.





Q: WHAT COMES TO MIND WHEN YOU THINK OF SOCIAL DETERMINANTS OF HEALTH?

Jesse Gavin: Social determinants are basically anything outside of the
interpersonal level that may affect a person’s individual health or wellness. I
think health literacy and continued education are really important because if I
hurt myself in March, but open enrollment information was provided back in
October, I’m not going to remember what was said. The continued conversation and
ability to communicate are key factors. I also think location and demographics
play a huge role in health because here in Houston, we have access to plenty of
healthy foods, but someone who lives in a rural or desert area may not have
these same food options. 

Erica Miller: I think social determinants of health are going to continue to
become much more prevalent in this space and because of that, all benefits
packages need to consider them for their populations. The most prominent
determinants are the places in which we work, live, play, learn, and worship. If
we are not designing appropriate benefits programs and analyzing the data to
include those key pieces, then we are not meeting people where they are. 

Jeanette Martin: Social determinants are what impact health more than anything
else and are the relationships with those around us and the environment. The way
we respond to and interact with our environmental factors – such as COVID-19,
political issues, and social unrest – directly influence the state of our
physical well-being. It is well-documented and supported in literature that a
healthy state of mind positively impacts a healthy physical self. Regulating our
exposure to negative messages greatly improves our state of mind, and social
media is a major influencer in what drives our daily emotional state.





Q: WHICH OF THE CATEGORIES OF SDOH DO YOU BELIEVE ARE MOST RELEVANT?

Jesse Gavin: Sometimes it can almost seem like an impossible task to solve all
of these issues for every person in your organization because everyone is so
different. For one, we have a diverse population, and it is important that our
employee-facing web portal has the ability to translate the information into
other languages besides English. This allows us to address any language or
communication barriers that may be in place. Additionally, we might have
employees that are severely depressed, some are not worried about physical
exercise, and some may be a single-parent household with three children and they
can’t fit any more time into their schedule. Social determinants of health are
very situational, which makes it very difficult.

Erica Miller: For a specific organization I work with, I would say that it is
built around education, because I think the other determinants can be improved
upon based on the levels of education and communication. They work diligently to
ensure that there are a multitude of modalities, as everybody learns
differently. They also take a blended approach and drip mechanism so that they
are providing continual awareness year-round, and not just one topic at a time.
Unless people feel comfortable and are well-informed of the programs, they won’t
properly engage. 

Jeanette Martin: I designed our wellness program based on 9 pillars of wellness
that include: social, intellectual, occupational, spiritual, cultural,
environmental, financial, physical, and emotional. Each of these areas of
wellness makes up the big wellness picture of our lives. If any one area is
seriously deficient, it will affect other areas of wellness. It’s important to
recognize that the goal is not to achieve perfection in any one area, but to
understand that finding balance is the key to harmony in life. Our program is
designed to address public health concerns that are relevant right now,
specifically within COVID-19 and the issues that come with it. These impacts are
felt across all pillars of wellness, and it is important that we offer resources
to make easy healthcare decisions and foster a sense of control over their
environments.

‍

Q: IS IT MORE IMPORTANT TO YOU TO CAPTURE PUBLICLY AVAILABLE DATA ACROSS THE
ENTIRE MEMBER POPULATION, OR TO CAPTURE VERY SPECIFIC DATA FROM A SET NUMBER OF
INDIVIDUALS?

Jesse Gavin: When you think about which is most important, it depends – we are
all different humans and we all have different needs. For example, our
population at Baylor College of Medicine is fairly young, so we don’t see a ton
of chronic conditions like heart disease or diabetes compared to the national
standard. But from aggregate level data, we know the younger generation is more
likely to have a wreck while texting and driving or risks more associated with
those behaviors. So for us, it makes more sense to focus on issues like that.
The ability to know your population and where they’re at in life is crucial in
addressing wellness-related issues.

Erica Miller: From a consultant perspective, we spend a lot of time with
individualized data. In order to help us be more granular in our approach, we
look at the data from several different vendor partners that have helped open my
eyes to the social vulnerability index. We can look at claims data in rural vs.
urban areas or neighborhoods with high vs. low crime rates using ZIP code
information. Additionally, we can access salary data, race and gender, and
education levels to compare groups. We can then look at these populations’
health risks, chronic diseases, and comorbidities to identify trends. We are in
the infancy of using the data to help drive and design benefits solutions. As we
continue to progress, connecting the multitude of data points will be
beneficial. 

Jeanette Martin: It really is both because once we identify the trends, we can
isolate what areas of priorities exist to better identify areas of concern and
determine if programs can be designed and implemented to address those concerns.

For the data to be truly meaningful as it relates to building our program, the
data has to come from local sources comparing companies like ours (industry and
size). Nationwide generalizations are not always an accurate representation of
health concerns in our geographic location. As it relates to our program’s
success, the Florida Department of Health statistics that can identify trends in
our geographic region, as well as our own internal claims analysis to identify
population health trends.





Q: WHAT ARE THE CHALLENGES THAT YOU PLAN TO USE SDOH TO HELP SOLVE?

Jesse Gavin: With the pandemic, obviously, telehealth visits increased and there
may be some perceived privacy concerns from the patient side. For example, if
someone has mental health issues and they live in a one- or two-bedroom home
with multiple other people, they may not feel comfortable talking with a mental
healthcare provider virtually. Because of that, many issues go unaddressed. SDOH
help us understand these differences in our populations and find alternate ways
to engage them. The pandemic took a sense of connection, and with our younger
population, many suffered from this feeling of isolation.

Erica Miller: We believe that how an individual interacts with their healthcare
ecosystem will affect how they will engage in the workplace. I think it is
important so that we understand our human capital management and how we can
continue to improve upon the entire benefits package. 

Additionally, even before the pandemic, isolation was one of the leading causes
of depression. Now we have been forced into isolation and some of us were more
capable of handling that than others. Some people lived alone and craved
interaction, while others may be looking for ways to also influence their
families at home. Considering these demographics is important in navigating
health programming effectively. 

Jeanette Martin: With the lingering COVID-19 virus and the Delta variant,
concerns change dramatically and PCP visits are experiencing an impact as
virtual visits increase. Risk can only be identified if there are trends
validated by data. Therefore, we are working to gain understanding of the SDOH
composition based on our program engagement and the analysis of claims data to
identify high-cost patterns. As we better understand our population and their
healthcare consumer habits, we can better appeal to their specific needs and
address their concerns. Our wellness program partners with our dining facility
and on-site fitness center to create a number of different educational seminars,
challenges, and programs that are available to all employees both in person and
virtually. With mental health being impacted heavily by the pandemic, we
designed our EAP program to include apps and services to address these concerns.
We also have a Licensed Mental Health Counselor and Psychologist on staff to
host webinars and regular discussions.


‍

ABOUT JENNIFER JONES




‍

Jennifer Jones, MSM RD, is an experienced healthcare professional with a
background in clinical dietetics, wellness programming, and employer health.
With over 20 years of experience, she has worked in various settings, including
healthcare systems, occupational health organizations and health and welfare
benefits advisory firms. After working directly with patients and employees,
Jennifer joined Springbuk, where she serves as the Population Health Practice
Leader, and turned her focus to population and employer health to achieve a
greater impact on health outcomes.

‍




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