Those with high SDoH stress are nearly 50 percent more likely to suffer from chronic conditions and 2.3 times more likely to rate their health as “fair” or “poor.” (Photo: Shutterstock)

Financial insecurity, social isolation, addiction and other social determinants of health (SDoH) can really make a difference in how people engage with their health care providers, according to Waystar's “2018 Consumer Perspectives on How Social Determinants Impact Clinical Experience.”

Waystar surveyed 500 U.S. consumers who have had a health care encounter within the past 12 months, and found that 68 percent of the respondents were challenged in some way by a social risk factor that impacted medical encounters at a hospital or physician office. Moreover, 52 percent have moderate to high risk in at least one SDoH category. Additional categories include housing insecurity, transportation access, food insecurity and health literacy, according to the survey report.

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“The most commonly reported SDoH issues are financial insecurity and social isolation,” the report's authors write. “This was consistent across payer classes, although the prevalence and severity differed. Health literacy had the lowest self-reported prevalence among the Medicare/Medicaid population, while food insecurity was the least common issue for the commercial population.”

Social risk factors can impede one's ability to improve and maintain their health, according to the survey results. While just 1 percent of the “low risk” respondents say that their issues caused them to miss at least one health care appointment per month, that rate quadrupled to 4 percent for those who say they are at “moderate risk” for social risk factors, and increased nearly another sixfold to 23 percent for those who are at “high risk.”

“To understand the SDoH challenges patients are facing, providers and payers are beginning to utilize screening tools—typically a survey of approximately a dozen questions that is either completed by the patients themselves or administered by a member of the care team,” the authors write. “This effort is far from universal due to issues of response and perception bias as well as resource limitations.”

Indeed, of all patients in the “high risk” segment, 60 percent never discussed their issues with a provider or their insurance company.

“Payers and clinicians are making efforts to understand the sociodemographic context of their patients and offer programming,” the authors write. “However, the activity is still limited and appears unevenly applied or done in a manner that consumers choose to reject today. Better methods are needed to target highest risk patients who would most benefit from assistance programs.”

Other key survey findings include:

• SDoH risk is present across payer classes: Every payer class has a sizable high-stress population. Government-funded insurance pools, Medicare or Medicaid, have the largest high-stress share: Nearly 60 percent of the combined Medicare-Medicaid community have moderate or high stress in at least one category and 33 percent have high stress in three or more.
• Health status and SDoH challenges correlate: Those with high SDoH stress are nearly 50 percent more likely to suffer from chronic conditions and 2.3 times more likely to rate their health as “fair” or “poor.”
• SDoH prevalence impacts ability to get and stay healthy in tangible ways: Patients with high SDoH risk are over three times more likely to miss multiple medical appointments per year.
• Patients with SDoH issues prefer to discuss them with providers over payers: Patients with SDoH issues are 2.5 times more willing to talk about those issues with clinicians compared to payers.
• Efforts to engage patients on SDoH issues are misapplied: Most conversations about SDoH are occurring with patients that are least likely to have health issues and least likely to utilize support services, if available.