What are social determinants of health relevant to value-based care and primary care physicians?

Providing value-based care requires a focus on overall health outcomes for the patient, a shift from the traditional fee-per-visit model of care that is focused on individual office visits. The primary care physician must look at the complete picture of a patient to understand what factors impact that patient’s current condition and future health. In addition to the usual factors of genetics, diet, and exercise, social determinants of health can also affect the patient’s well-being.

Social determinants of health include socioeconomic factors, education level, economic environment, job opportunities, and social supports, “conditions in the places where people live, learn, work, and play” that “affect a wide range of health risks and outcomes.”

Socioeconomic factors are significant social determinants of health. Patients who are low-income may be challenged with finding a job because of the economic environment in which they live, a lack of education or training, or other reasons related to their background or environment. When considering socioeconomic factors, the primary care physician must understand whether an order to eat healthier can actually be carried out by the patient who may face challenges with being able to purchase high quality food.

Simple access to healthcare can also be a barrier for the primary care physician’s patients. Transportation may not be available or the patient may not be able to afford transportation to the provider’s office. Providing value-based care to these patients may require innovative solutions such as electronic communication or telehealth provided through a satellite location.

Social supports are important to the patient impacted by social determinants of health. The primary care physician may need to reach out to family or the community, while adhering to HIPAA regulations, to encourage the patient to continue to take advantage of the quality healthcare and to follow the care plan laid out by the physician.

Social determinants of health can significantly impact a patient’s well-being. Providing value-based care to such patients will require outreach and continued support on the part of the primary care physician.