CentraForce Health Observations and Insights

Dr. Newman Responds: The Best Way to Address Social Determinants of Health

Posted by Stephen L. Newman M.D. on Mar 14, 2019 3:13:21 PM

Recently, an article in Modern Healthcare, Local solutions, broad collaboration offer best way to address social determinants of health, caught our attention.  This Op Ed was published by Margaret Murray, the CEO of the Association for Community Affiliated Plans. Her discussion on the importance of integrating Social Determinants of Health (SDoH) by providers and payers reflects the great work done by the Association and its members in providing such critically needed care and services in the communities they serve.

Stephen Newman, M.D., Executive Chairman and Chief Medical Officer of CentraForce Health adds his perspective below:


I would like to amplify upon Ms. Murray’s perspective as I believe it is incumbent upon all of us as payers and providers to build upon this foundational work and take the logical next steps. For decades, the delivery and management of healthcare has focused our care strategies on insights derived from a retrospective set of encounter data. These data are derived from the analysis of electronic health records (and medical records prior to the advent of EHR's) and insurance claims data. We designed a system that, for the most part, only treats the sick after lapses in health because we must wait for them, rather than proactively administering preventive treatment. The limitations of this retrospective data, and the analysis derived therefrom, prevent us from better understanding the seemingly healthy, yet at risk, 85 percent of the population that have not been hospitalized nor have had few ambulatory encounters or a pattern of insurance claims.

Hence, we remain locked in a small box, repeatedly treating the 15 percent of people who consume 80 percent of our healthcare resources today. This reactive care is laudable and has improved the quality of life of those with chronic disease and successfully kept a portion of this population out of emergency departments and hospitals. However, we continue to miss the opportunities to better care for those hundreds of millions of US citizens who have not yet appeared on our “radar” with an acute or chronic disease. I refer to these seemingly healthy people as the “invisibles.”

We can and must help them. This is a daunting task because we know little to nothing about their health status, risks and propensities. This information could unearth actionable insights that could help identify these invisibles before they have costly or catastrophic health encounters. Yet, without critical data, we tend to ignore them. We have both a moral and financial obligation to better care for the “invisibles.” So, how do we get the actionable insights on the invisibles we so desperately need?

Enter Non-Traditional Data. These data are not included in insurance claims or EHR's, but, when properly understood and utilized, allow us to identify those seemingly healthy individuals that are at high risk for the onset of acute or chronic disease. If we can prospectively identify the individuals at risk, it is possible to intervene to prevent disease or change the natural history of a disease for a portion of this cohort. In short, we could proactively initiate conversations with them, recommend lifestyle changes, connect them with appropriate community resources or augmented medical treatment that could improve or even save a life.

In order to do this, we need to know what is happening in the critical 4,000 hours between their visits to a primary care provider. The overarching question remains -- where can we get the critical health behaviors, attitudes, and propensities that strongly influence health status and their interaction with our healthcare delivery system. It is now generally accepted that socioeconomic factors, when added to these previously unknowable factors and insights could be responsible for at least 50 percent of the total influences on healthcare outcomes. Unfortunately, it has been and will remain a struggle to gather additional information by directly asking patients, especially considering the resources needed to gather this data person by person. One-on-one conversations have been a well-documented failure generating sufficient ROI to be done at scale.  

So, where can we get that data on specific health behaviors, attitudes and propensities? Fortunately, there is a treasure trove of this data gathered by the nation’s largest consumer research companies. However, there are two reasons we can’t simply license these large-scale datasets and append them to our patients or members. First, this consumer research is anonymous self-reported data to ensure the privacy of the individuals participating in these surveys. Second, there are tens of millions of data points in these surveys of which only a relatively small number are directly related to health conditions, attitudes and behaviors. This important health-related information is spread across well more than a dozen national studies, making it impractical for a provider or payer to separate the signal from the noise.

We need a new approach, a set of easy-to-use and easy-to-understand tools to integrate all of the health-related data from these disparate datasets thereby creating a unique new data set of actionable insights which identify the invisibles who are at risk and provide us the ability to change the way we talk with and treat our patients or members. Only then can we actually change the way we render care and manage resources, simultaneously improving health outcomes and reducing costs. By creating a 360 degree of our patients and members outside of the care setting, then and only then can we begin the move our healthcare system from focusing on sick care to focusing on well care. Developing a system to care for those “invisibles” health, while improving our care of those with non-preventable chronic disease, would be true healthcare reform.


Stephen L. Newman, M.D.
Executive Chairman and Chief Medical Officer
CentraForce Health
COO (retired)
Tenet Healthcare

Topics: Social Determinants of Health