In an environment increasingly focused on whole-person health, addressing social determinants of health (SDoH)—the nonmedical factors that influence health outcomes—is key for providers looking to improve patient outcomes and deliver on expectations from the evolving healthcare system (see sidebar, “Definitions”). Indeed, as a trusted source of care and information, providers can play an important role in the effort to meet people’s basic needs.
To understand where providers are in their journey to support these needs, we conducted a survey among 75 provider systems across the United States regarding their prioritization, resourcing, capabilities, and programming for SDoH. These findings provide a landscape view of both where providers are today and where they aspire to be.
While most providers say they are prioritizing and investing in SDoH, they have an opportunity to move from siloed, one-off efforts for select patient groups to comprehensive efforts supporting whole-person health at scale.
About the survey
This article primarily uses data from the McKinsey Social Determinants of Health Provider Survey conducted in December 2021. The survey was a 30-minute, online poll of 75 providers across the United States who could speak about SDoH-related efforts within their organizations. To better reflect the variety of provider types that exist across the United States, the survey included a representative number of providers by type (for example, academic medical center, children’s, safety net, and community), size (for example, by revenue and number of beds), geography (for example, rural, urban, and suburban), and payer mix (for example, Medicare, Medicaid, and commercial).
Given the limitations of online surveys, it is possible that biases were introduced as a result of undercoverage or nonresponse.
Intention versus action
Most providers reported that they prioritize SDoH. Academic medical centers (AMCs), hospitals that are part of larger systems, and hospitals that engage in greater risk sharing are among those that most often reported “highly prioritizing” SDoH.
But while providers recognize that social determinants of health are important and prioritize them conceptually, few have developed the capabilities needed to achieve the desired outcome. This lack of capabilities could adversely affect both physicians and patients—with patients facing challenges in getting their basic needs met and physicians struggling with burnout from the limited support available to them to address those needs. Recent findings substantiate this: six in ten physicians report feeling inadequately resourced and burned out in their efforts to address SDoH.
While no provider can meet all basic needs—nor should they feel the pressure to—provider systems can increasingly invest in and prioritize SDoH capabilities to better support patients and physicians.
What capabilities are most needed?
By and large, providers reported a need to improve SDoH capabilities. The greatest potential exists in the further development of coding and billing, direct programming, and vendor partnerships.
Community partnerships can be a relative strength, but providers may want to consider how effectively these partnerships are addressing patients’ unmet basic needs—ensuring they are not just one-off projects but a core piece of how care is delivered.
44% of providers at most are very strong in a given SDoH capability. Instead, in nearly every capability, most providers have select elements that they must further develop.
Where providers are investing and why
Providers’ investments reveal that many are increasingly acting to address SDoH. Many divide these investments—which often come from grants and donations, followed by self-funding, federal or state support, or other sources—into small sums across a variety of focus areas. Providers typically choose investment areas based either on community or patient needs (receiving grants for specific focus area) or on the feasibility of supporting these areas given existing provider capabilities. However, it is not clear whether areas of investment are the most important areas for impact.
The amount that providers are investing must be contextualized by provider size and local need. That is, investment is relative to bed size or revenue, and areas with more poverty may warrant larger SDoH investment from providers. A breakdown of SDoH investment by provider size reveals that, across the spectrum, providers are investing less than 1 percent of total revenue, and $1 million to $5 million remains the most common investment size across providers (for example, nearly 40 to 70 percent of providers across bed sizes invest within this range). Providers with more than 1,000 beds make up the entirety of those investing more than $10 million.
Improving screening capabilities and potential actions
While 72 percent of providers said they conduct screening during patient intake, the majority are not currently taking actions that could optimize the screening process, such as partnering with a vendor or harnessing predictive analytics. In addition, just 1 percent screen for the exhaustive set of unmet basic needs or social factors recommended in the PRAPARE tool—a nationally recognized, standardized patient social-risk assessment protocol.
This suggests that greater standardization could help identify a broader set of unmet basic needs.
Without the support of technology and workflow integration, screening for the full set of unmet basic needs can be time consuming with limited reimbursement. To increase standardization and ease of screening, providers may consider further capability building in this space.
1% of providers screen patients for the full set of unmet basic needs, though 72% do some screening during patient intake.
The programming gap
Across unmet basic needs, providers appear to be more robust in screening for SDoH needs than in offering programming to address those needs; overall, fewer than half of providers said they have determinant-specific programming, and just one-third have KPIs in place to track the impact of offerings.
However, most providers said they have community partnerships and care coordination offerings, and nearly half offer closed-loop referrals to address unmet basic needs—all options that could relieve the need for direct programming.
Overall, providers could bolster their SDoH programming, both in offerings and measurement. Additional analysis may be useful for determining the prevalence of these needs among patient populations compared with programming offered.
Just one-third of providers have KPIs in place to track the impact of offerings.
Recognizing that healthcare workers face unmet basic needs
Recent research has confirmed that employees of provider systems face unmet basic needs; for instance, nearly 20 percent of healthcare support workers (roughly one in five of all those employed in the industry) face food insecurity.
A recent McKinsey survey on health equity in the workplace found that employees with one or more unmet basic needs are 2.4 times more likely to have missed six or more days of work in the past year and to have not received needed physical healthcare.
Providers could address this situation by attending not only to patients’ unmet basic needs but also to those of their employees.
39% of providers determine which unmet basic needs they will focus on by surveying employees.
Financial resources: The key to addressing unmet basic needs
Providers noted that several broader ecosystem actions could help them address patients’ unmet basic needs, with financial support rising to the top. To unlock more financial support, providers may consider measuring and clearly articulating the ROI of their SDoH efforts. They can be rigorous in tracking and documenting the downstream effects of these investments—on health outcomes, key indicators, and value—to both inform high-impact activities across the system and bolster the case for more funding and resources.
To unlock more financial support, providers may consider measuring and clearly articulating the ROI of their SDoH efforts.
Providers can consider a variety of tactical actions.
As trusted sources of healthcare and information, providers play a vital role in addressing patients’ unmet basic needs. Providers are increasingly prioritizing and investing in social determinants of health, according to our survey, but they have room for growth in bolstering capabilities, providing more robust programming, and codifying accountability. The following seven actions could help providers build on existing efforts and optimize impact in addressing SDoH for their patient populations:
- Link unmet basic needs to key priorities. Take an SDoH lens to mission-critical strategic priorities, such as value-based care, quality improvement, patient engagement, and risk adjustment.
- Organize for success. Identify an executive lead, build a cross-functional leadership team, establish SDoH measures, align incentives, and incorporate patient voices.
- Collect data to inform interventions. Determine data needs, implement comprehensive screening processes with support from electronic health records, and ensure that assessments of community health needs are actionable.
- Make informed financial commitments. Conduct additional research, identify the highest-impact SDoH interventions, and focus investments on related programming and efforts.
- Develop a referral and support infrastructure. Establish an infrastructure to connect patients with services and invest in resource coordinators to help patients meet needs.
- Measure outcomes and share successes. Define measures that are linked with strategic KPIs, track performance, make iterative adjustments, and share findings.
- Convene and lead external SDoH activities. Partner with others to address unmet basic needs in communities, consider becoming an anchor organization to improve social factors, and review opportunities to meet employees’ unmet basic needs.
To learn more about the impact of social determinants of health, see Tamara Baer, Erica Coe, Anne Koffel, and Jordan VanLare, “Patients struggle with unmet basic needs: Medical providers can help,” McKinsey, April 1, 2022.