For most patients, genetics and lifestyle choices are an important driver of health — but they’re far from the only ones. Social and environmental factors, known collectively as social determinants, are a big part of the equation.
We often find that regardless of the reason a patient seeks the care of a provider, the root of the problem is a social or environmental factor.
Dr. Stephen Spann, founding dean of The University of Houston College of Medicine shares:
“I would emphasize the paradigm in primary care, which is the biopsychosocial model. We don't divvy people up into physical, mental, social and spiritual dysfunction. We look at them as a whole. A patient may come in to see me because of chronic low back pain. But it's really related to depression and not the intrinsic back pathology.
"However, I will treat the whole person. I will deal with the depression and the back pain. My commitment will be to get the patient well. It's a unique approach; remember that 50% of problems that patients bring to their primary care doctors are not biological. They're psychosocial.”
We can spend an exorbitant amount of time addressing physical symptoms in an exam room, only to discover that they have their roots in non-medical conditions.
Approaching patients with a biopsychosocial approach means we’re meeting them where they are, understanding the context of their lives, and working in a way that helps alleviate the social and environmental determinants contributing to their problems.
Ryan Schmid, Vera’s President & CEO, says, “Being aware of social and environmental determinants allows us to train our people differently, to think differently, to operate differently, to impact communities. We're radically focused on populations because we’re not just putting a Band-Aid on the problem but addressing the root causes.”
What Are Social Determinants?
When we talk about social and environmental determinants, we’re looking at the nonmedical factors and conditions that can impact a person’s health outcomes and overall wellbeing.
Here are some of the most common determinants of health:
1. Home situation
Understanding a patient’s living conditions and home situation not only helps ascertain potential physical risk factors, but also helps unpack the presence of a support system, engagement within the community, and issues of accessibility to health services.
2. Family economic stability
Many times, a person’s economic situation is a key element in understanding the friction points that stand between them and the medical care they need. Whether it’s cost alone, competing priorities, or insecure employment conditions, a patient’s economic situation is a deciding factor in health.
What are the patient’s work hours? Do they work in a demanding environment with little time for recovery? If they have a spouse, what is that person’s work environment? Most people spend more time at work than they will with their own families — and even family time is impacted by what’s going on at work. Understanding their that context will provide critical insight into the factors affecting their overall health.
In a value-based system, there’s a significant push to better understand social determinants, and a need for strategies to meet patients where they are in order to drive better outcomes.
Advanced primary care is about gathering information to paint a broader, more detailed picture of each individual patient with the goal of keeping them healthy. When you understand a patient, when you have a fuller picture, you’re able to serve them more effectively.
For instance, if a population is primarily Spanish-speaking, you prevent friction in the healthcare experience by staffing your care center with providers and teams who are bilingual. If you’re serving in a rural area where transportation is a hindrance, you can provide better access with services like telehealth and online health portals.
That’s why we’ve focused our attention on data-driven advanced primary care — to learn as much as possible about the population’s risks to better equip our care teams to provide the services and outreach a specific clinic needs.