IMPLEMENTING SDOH SCREENINGS: WHICH ONES? Panel Chair : Angela - - PowerPoint PPT Presentation

Panel Chair: Angela Hagan, Humana Inc. Speakers: Caroline Fichtenberg, University of California, San Francisco Jessa (Engelberg) Anderson, West Health Institute Clare Tanner, Michigan Public Health Institute/ DASH

IMPLEMENTING SDOH SCREENINGS: WHICH ONES?

To what type of organization or profession do you belong? You are….

• Academic or Research
• Payer
• Health System or Provider
• Vendors
• Policy/Government
• Other?

Audience Poll Slido.com #SDOHscreenings

In 2019, Humana screened over 100,000 members for social needs, which accomplished these objectives: 1. Fed Humana’s SDOH data ecosystem by surveying members on a comprehensive set of social need domains, including financial strain, housing insecurity and quality, and transportation access. 2. Evaluated multiple comprehensive screening tools based on Humana business needs and member willingness to complete full survey and select tool to recommend to use across enterprise. 3. Evaluated member willingness to complete a survey of 12–16 questions with multi- channel outreach campaign, including Interactive Voice Response (IVR), email and SMS text.

Comprehensive Social Need Screening Channel Test

• The Accountable Health Communities (AHC) Health-Related Social Needs

Screening Tool developed by the Center for Medicare and Medicaid Innovation (CMMI)

• Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences

(PRAPARE) developed by the National Association of Community Health Centers

• Senior-Specific Social Needs Screener developed by University of California Irvine

Health School of Medicine and the West Health Institute

Comprehensive social need screening tools evaluated

• What types of populations are you serving or studying?
• Seniors
• Working age adults
• Pediatric
• Specific condition, situation or need-based?

Audience Poll Slido.com #SDOHscreenings

Caroline Fichtenberg, PhD Social Interventions Research and Evaluation Network (SIREN) University of California, San Francisco

Social Risk Screening in Healthcare: State of the Science

February 10, 2010 Datapalooza

Prevalence of screening for social risk factors in US Health Care Orgs

92% 24% 67% 16% Screen for at least 1 social risk Screen for all 5 social risks

Hospitals Practices

Source: Fraze et al. Prevalence of Screening for Food Insecurity, Housing Instability, Utility Needs, Transportation Needs, and Interpersonal Violence by US Physician Practices and Hospitals. JAMA Netw Open. 2019 Sep 4;2(9).

Open questions

• What to screen for?
• How to screen?
• Who should do the

screening?

https://sirenetwork.ucsf.edu/tools-resources/mmi/screening-tools-comparison

Have tools been validated?

Henrikson NB, Blasi PR, Dorsey CN, et al. Psychometric and pragmatic properties of social risk screening tools: A systematic review. Am J Prev Med. 2019;57(6):S13-S24.

Review of validity testing of social risk screening tools Among 21 tools identified:

• No tools followed all 8 steps of gold standard measure

development

• Only 8/21 reported some reliability or validity testing

Question wording matters

94% 82% 91% 83% 76% 93% 72% 96% 0% 50% 100% 150%

Sensitivity Specificity Sensitivity Specificity

HVS (often, sometimes, never response

• ptions)

12 month recall 30 day

Makelarski JA, Abramsohn E, Benjamin JH, Du S, Lindau ST. Diagnostic accuracy of two food insecurity screeners recommended for use in health care settings. Am J Public Health. 2017;107(11):1812-1817. Gold standard: 6-item Household Food Security Screen

Face to face: 18% Self administered via tablet: 24% (33% percent more) Food insecurity among pediatric caregivers in an urban children’s hospital ED

Cullen D, Woodford A, Fein J. Food for thought: A randomized trial of food insecurity screening in the emergency

• department. Acad Pediatr, 2019; 19(6).

Screening modality matters

Patient/ Caregiver Acceptability is High

De Marchis EH, Hessler D, Fichtenberg C, et al. Part I: A quantitative study of social risk screening acceptability in patients and caregivers. Am J Prev Med. 2019;57(6):S25-S37.

Interest in assistance, by social risk screening result (n=1,000)

37% 35% 35% 40% 11% 8% 4% 8% 5% 2%

0% 20% 40% 60% 80% 100%

Housing Food Utilities Transportation Personal safety

Interest in Assistance

Screened positive Screened negative

From De Marchis E. North American Primary Care Research Group Annual Meeting. 2019.

Where does this leave us?

No standard tool yet Patient acceptability of screening is high How you ask questions can change the responses Screening positive ≠ wanting assistance

Making progress but still a ways to go

Caroline.Fichtenberg@ucsf.edu https://sirenetwork.ucsf.edu @SIREN_UCSF

Is your organization using a health-related social needs/social determinants of health screener? If so, which:

• Not using
• Accountable Health Communities
• PRAPARE
• Other comprehensive set
• Mixture of questions from different tools/custom-developed
• Single domain focused screener, e.g. for food insecurity

Audience Poll Slido.com #SDOHscreenings

Jessa (Engelberg) Anderson, PhD Prior affiliation: West Health Institute Current affiliation: ServiceNow

DEVELOPING A SENIOR- SPECIFIC SOCIAL NEEDS SCREENER

In-need Irene

• Lives alone in an apartment
• Poorly managed chronic conditions
• 4 overnight hospital stays in the past year
• Utilities frequently shut off
• Eats primarily fast food
• Difficulty moving around
• Limited social contact
• Wants to feel better but isn’t sure how
• Wants to stay in her home, but afraid of being put in a

nursing home

Developing the senior-specific social needs screener

• Literature review
• Comparison table of existing social screener items
• Expert meetings to develop initial 11-item screener
• User feedback
• Pre-testing
• Patient Family Advisory Committee
• Applied feedback to modify

Simplified Screening & Response Workflow

Screen Positive Connect to Care Navigator Follow-up using care plan/s Identify need/s Comm- unity Referral Follow-up re: need/s met

Screen + on any question across seven social needs domains: 1) Social Connection/Isolation, 2) Daily Living/Mobility, 3) Caregiver Needs, 4) Food/Nutrition, 5) Housing, 6) Transportation, 7) Financial

EXAMPLE OF A NUTRITION- SPECIFIC FOLLOW-UP CARE PLAN

Pilot Data: Screening and Response

170 Screened 62 Screened + 48 Agreed to Connect to CN 39 Connected 19 Referrals

Key Takeaways

• Patients
• Appreciate being asked about social needs
• Time to understand purpose and build trust
• SeniorHealth Center
• Culture shift
• Broader acceptance of social needs and role
• Community-based organization
• Eager to partner with health care
• Difficult to “close-the-loop”

Guide available to download here

Appendix

Rationale for senior-specific social needs screener

• Conducted formative research to understand

local context and barriers

• Identified opportunity to improve care

coordination by identifying social needs

• No standardized screening for social needs
• Concerned with logistics
• Lack of available resources, time constraints,

and costs

Creating a Screener and Evaluation

• 1. Developed, tested and modified a senior-focused social needs screening tool
• 2. Identified follow-up assessments and developed workflows for screening,

follow-up, and response

• 3. Selected key process and outcome data points for analysis

Key outcomes

• Quantitative
• Patient-reported
• Utilization data
• Screening rates
• Qualitative
• Interviews
• Patient stories

Results: Hospitalizations & ED Visits

Likelihood of having one or more overnight hospitalizations in the prior 6 months (n=170) Odds Ratio p-value 95% CI Screened Positive for >1 social needs 3.16 .035 1.09, 9.18

Controlled for sex, race/ethnicity, age, number of chronic conditions

Likelihood of having one or more ED visits in the prior 6 months (n=170) Odds Ratio p-value 95% CI Screened Positive for >1 social needs 2.09 .088 0.90, 4.89

Scaling and Spreading

• Sustain at the SeniorHealth Center
• Use workflows with complex ACO patients
• Medicare Annual Wellness Visit template and

incorporate into EHR

• Spread
• UCSD adopting Annual Wellness Visit template
• Scale
• Humana testing
• Practical Guide to Addressing the Social Needs of

Older Adults

• Available to download here

Perspectives from systems, clinics, providers, payers, nonprofits

Clare Tanner, PhD Health Datapalooza, February 10, 2020

DA TA A CROSS SECTORS FOR HEA LTH DA SHCONNECT.ORG A LL IN: DA TA FOR COMMUNITY HEA LTH A LLINDA TA .ORG

Data Across Sectors for Health (DASH)

DASH is led by the Illinois Public Health Institute, in partnership with the Michigan Public Health Institute, with support from the Robert Wood Johnson Foundation.

DA TA A CROSS SECTORS FOR HEA LTH DA SHCONNECT.ORG A LL IN: DA TA FOR COMMUNITY HEA LTH A LLINDA TA .ORG

DASH integrates 3 strategies + policy development & systems change

Policy & Systems Change

Build local capacity Build the Evidence Base Build the Movement

DA TA A CROSS SECTORS FOR HEA LTH DA SHCONNECT.ORG A LL IN: DA TA FOR COMMUNITY HEA LTH A LLINDA TA .ORG

Pew Charitable Trusts Health Impact Project

Past Partners: Community Health Peer Learning Program, Connecting Communities and Care Current Network Partners:

Some Definitions

Source: : HealthBegins (2019). Upstream Communications Toolkit.

https://www.healthbegins.org/uploads/2/ 2/0/4/22040328/upstream_communicati

• ns_toolkit_-_may_2019.pdf

DA TA A CROSS SECTORS FOR HEA LTH DA SHCONNECT.ORG A LL IN: DA TA FOR COMMUNITY HEA LTH A LLINDA TA .ORG

Approaches to Effective Screening for Social Needs (draft agenda for All In affinity group)

Key Questions to Address

• Why do we screen?
• How do we screen?
• Questions
• Length of screening
• Mechanism for collecting the data
• Who do we screen (and not screen)?
• When do we screen?
• What do we do with the information?
• How do we know if it works?

Key Challenge

• Screening Standardization
• Interoperability
• Report out
• Common screening

language

Screening and other shared data use cases

73% 66% 65% 64% 56% 51% 45% 31% 29% Sending and receiving of referrals and… Quality and performance measurement Client intake & service eligibility… Client prioritization/targeting Community Resource Directory Sending/pushing of alerts and… Person/family centered ‘shared care … Appropriate setting/diversion programs Care coordination not otherwise…

Data from All In National Inventory as of September 2019, n=94 of 210 collaborations who indicate ‘screening & assessment’ as a shared data use case also chose

DA TA A CROSS SECTORS FOR HEA LTH DA SHCONNECT.ORG A LL IN: DA TA FOR COMMUNITY HEA LTH A LLINDA TA .ORG

Multi-sector Data Sharing

(not necessarily screening data)

Data from All In National Inventory as of September 2019, n=94 of 210 collaborations who indicate ‘screening & assessment’ as a shared data use case

75 56 55 48 46 21 47 32 35 31 25 15 27

Healthcare Public Health Social Services Behavioral health Other CBO Research Housing Local government Food Education Justice Faith based Law enforcement

62 58 57 45 45 38 38 37 31 29 24 23 23

Data S Sourc rce Data Us a User

Breaking Down Barriers: Strategies for Addressing Food Insecurity in the FQHC Setting

Deena Pourshaban and Nadine Romero, Los Angeles Practice Transformation Network and Community Clinic Association of LA County

• All In National

Meeting, 2019

Using Data-sharing Platforms to Address Homelessness and Poverty: The Jackson Care Hub

Michael Klinkman, MD, MS and Bob Fike, Ph.D. - All In National Meeting, 2019

Michael Klinkman, MD, MS and Bob Fike, Ph.D. - All In National Meeting, 2019

What is important to people?

“Improving Health, Economic and Education Outcomes with NE Spokane Families and Neighborhoods”

• Jene Ray and Molly Merkle, All In National Meeting, 2019
• Prioritized Indicators and Strategies through the Results Based Accountability (RBA) process with

residents and providers working side by side

• Developed intake (aligned to Indicators) and goal setting frameworks for households co-designed

by families and Community Health Workers (Family Advocates) who are at sites throughout the Zone.

• 6 months of resident interviews, focus groups, and surveys (actively sought out diversity by

location, language, age)

• Gathered hundreds of data points from partners and connected them to our resident listening

project

• Built out the County HMIS Data platform for multi-sector, multi partner sharing of data and

DA TA A CROSS SECTORS FOR HEA LTH DA SHCONNECT.ORG A LL IN: DA TA FOR COMMUNITY HEA LTH A LLINDA TA .ORG

DA TA A CROSS SECTORS FOR HEA LTH DA SHCONNECT.ORG A LL IN: DA TA FOR COMMUNITY HEA LTH A LLINDA TA .ORG

Sources

All In National Inventory

• Captured as of September 19, 2020
• 210 collaborations actively working on multi-sector data sharing
• 94 answered that as part of their ‘Whole Person Care’ approach they were engaged in screening or

assessment for health or social needs

All In National Meeting, held in Baltimore, MD October 15-17, 2019

• Pourshaban and Romero, “Breaking Down Barriers: Strategies for Addressing Food Insecurity in the

FQHC Setting”

• Klinkman and Fike, “Using Data-sharing Platforms to Address Homelessness and Poverty: The Jackson

Care Hub”

• Rey and Merkle, “Improving Health, Economic and Education Outcomes with NE Spokane Families and

Neighborhoods”