Thosewith high SDoH stress are nearly 50 percent more likely to sufferfrom chronic conditions and 2.3 times more likely to rate theirhealth as “fair” or “poor.” (Photo: Shutterstock)

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

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

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“The most commonly reported SDoH issues are financial insecurityand social isolation,” the report's authors write. “This wasconsistent across payer classes, although the prevalence andseverity differed. Health literacy had the lowest self-reportedprevalence among the Medicare/Medicaid population, while foodinsecurity was the least common issue for the commercialpopulation.”

Social risk factors can impede one's ability to improve andmaintain their health, according to the survey results. While just1 percent of the “low risk” respondents say that their issuescaused 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 nearlyanother 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 screeningtools—typically a survey of approximately a dozen questions that iseither completed by the patients themselves or administered by amember of the care team,” the authors write. “This effort is farfrom universal due to issues of response and perception bias aswell as resource limitations.”

Indeed, of all patients in the “high risk” segment, 60 percentnever discussed their issues with a provider or their insurancecompany.

“Payers and clinicians are making efforts to understand thesociodemographic context of their patients and offer programming,”the authors write. “However, the activity is still limited andappears unevenly applied or done in a manner that consumers chooseto reject today. Better methods are needed to target highest riskpatients 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 thelargest high-stress share: Nearly 60 percent of the combinedMedicare-Medicaid community have moderate or high stress in atleast one category and 33 percent have high stress in three ormore.
• Health status and SDoH challenges correlate:Those with high SDoH stress are nearly 50 percent more likely tosuffer from chronic conditions and 2.3 times more likely to ratetheir health as “fair” or “poor.”
• SDoH prevalence impacts ability to get and stay healthyin tangible ways: Patients with high SDoH risk are overthree times more likely to miss multiple medical appointments peryear.
• Patients with SDoH issues prefer to discuss them withproviders over payers: Patients with SDoH issues are 2.5times more willing to talk about those issues with clinicianscompared to payers.
• Efforts to engage patients on SDoH issues aremisapplied: Most conversations about SDoH are occurringwith patients that are least likely to have health issues and leastlikely to utilize support services, if available.