New resources aim to help primary care physicians address social drivers of health

Key takeaways:

• Although most physicians agree addressing social drivers of health is critical to good patient outcomes, it is complicated to do.
• The Physicians Foundation launched an initiative to support physicians’ efforts.

Addressing social drivers of health is critical but complicated, according to experts.

Gary Price, MD, president of The Physicians Foundation, told Healio that it is “essential for all physicians to understand and address drivers of health (DOH) to ensure the best health outcomes for their patients.” However, primary care physicians have an especially important role, “as they may see their patients on a more regular basis than other physicians.”

“They are often the first point of contact for patients within a health care system, giving them opportunities to screen for and have conversations with their patients about DOH,” Price said. “Primary care physicians also focus on disease prevention, and addressing DOH is a crucial component of preventing disease and maintaining overall health and well-being.”

In late April, The Physicians Foundation launched an initiative called “Let’s Take 5 to Address Drivers of Health,” to support physicians in addressing DOH, which are also commonly referred to as social determinants of health (SDOH). The five key types of DOH are housing stability, food security, interpersonal safety, transportation access and utilities access, according to The Physicians Foundation.

The initiative

Let’s Take 5 to Address Drivers of Health includes two resources to help support physicians: the Let’s Take 5 Conversation Starter and the Let’s Take 5 Steps Implementation Guide.

“We are dedicated to helping physicians address this issue, and this new initiative is an inflection point in drawing attention to DOH and the enormous impact they have on health outcomes and health care costs,” Price said.

The Conversation Starter serves as a guide to help physicians take the first step in addressing DOH and have critical conversations with patients.

“Discussing DOH is an ongoing process, and it can also be sensitive for patients,” Price said. “The Let’s Take 5 Conversation Starter provides advice through a five-step guide for physicians and their teams to start these essential conversations with patients in a way that is empathetic, empowering and actionable.”

The Implementation Guide is a resource with five steps to help physicians integrate screenings for DOH through clinically validated workflow approaches.

“A key step practices can take to address DOH is integrating DOH screenings, where patients are routinely asked questions about their DOH and answers are documented,” Price said. “By screening for DOH, patients can be connected with the appropriate community or health service to reduce the impact of DOH on their health and well-being. Furthermore, by implementing the right strategies and structures, physicians and their teams can more effectively support their patients.”

Price emphasized that addressing DOH is an “ongoing and complex issue” and the resources “are not an end-all solution.”

“Our hope is that equipping physicians and their teams with these resources will be a starting point and a push in the right direction for physicians to not only be able to address their patients’ needs, but also be empowered to do so,” he said. “The initiative supports physicians to address DOH so their patients’ health outcomes are no longer dependent on the key types of DOH, ultimately improving health outcomes for all patients and the state of our health care system.”

Burnout

Rita K. Kuwahara, MD, MIH, a primary care internal medicine physician and Healio Primary Care Peer Perspective Board Member, said that physicians “rarely have the time or training” to address DOH, leading to frustration and, in turn, burnout. Therefore, “it is important to implement interprofessional health care teams to comprehensively identify and address social determinants of health.”

“When patients’ basic needs are not met, it makes it challenging to maintain good health,” Kuwahara said. “When patients have poor health outcomes that could have been prevented, it certainly contributes to physician burnout.”

One of the initiative’s goals is to reduce burnout by providing physicians with support and resources to address DOH, Price said.

Price referenced The Physician Foundation’s 2022 survey, in which 80% of physicians reported that frustrations in addressing patients’ DOH contribute to burnout rates and 60% of physicians reported feeling they have little to no time or ability to address DOH.

Most of the physicians — 80% — also agreed that they did not think the United States could improve health outcomes or reduce health care costs without first addressing DOH. Price also said that physicians “face significant obstacles in their efforts to address patients’ DOH.”

“Most physicians want to address these issues for their patients. When they are not able to do so, it can be disheartening and take a toll on their professional morale and well-being,” Price said. “It is so critical that we give physicians the support they need to address these challenges in a way that is realistic and tangible for them.”

Price said he is optimistic that the initiative “will make a positive impact and reduce burnout through our clear, actionable resources.”

Compensation

One difficulty in physicians addressing DOH is compensation — or lack thereof — for screening and discussing these issues with patients.

However, Price said that Z codes can be used in many cases “to better document the increased level of complexity these patients can require in existing ICD-10 coding.”

Additionally, this is the first year that screening for DOH has been included in CMS’s Merit-Based Incentive Payment System (MIPS) quality incentive program, Price said. The Physicians Foundation “played an active role in establishing” this, the first federal DOH screening quality measure, he added.

“Within the implementation guide, we provide additional resources to submit this measure through MIPS,” he said. “CMS continues to improve DOH measurement and to evolve the submission process. It is our hope that the collection of this new data will continue to foster investments in and financing incentives for the care of these patients.”

References:

• Let’s take 5. https://physiciansfoundation.org/drivers-of-health/letstake5/. Accessed May 17, 2023.
• Let’s take 5 conversation starter. https://physiciansfoundation.org/wp-content/uploads/2023/04/PF23_DOH-Campaign_CoversationGuide_V1k.pdf. Accessed May 17, 2023.
• Let’s take 5 steps implementation guide. https://physiciansfoundation.org/wp-content/uploads/2023/04/PF23_DOH_Take5StepsImplementationGuide_V1i.pdf. Accessed May 17, 2023.
• The Physicians Foundation 2022 Physician Survey. https://physiciansfoundation.org/physician-and-patient-surveys/the-physicians-foundation-2022-physician-survey-part-1/. Accessed May 17, 2023.