Jennifer Jones, MSM RD
September 28, 2021
At Springbuk, some of the most common questions we are asked have to do with why certain groups have low levels of engagement, more gaps in care than their general population, and how to ensure that the right programs are in place for the right populations. While it sounds simple, the reason is not all groups are the same. More recently, employers are being challenged to address Social Determinants of Health as a way to address access and outcomes for members and the impact of health benefits and programs.
Based on this year’s Healthiest Employers data, only 45.2% of applicants indicated that they are analyzing social determinants of health (SDOH) when evaluating their benefits and wellness programs.
The CDC identifies five main components of SDOH:
- Healthcare Access and Quality
- Education Access and Quality
- Social and Community Context
- Economic Stability
- Neighborhood and Built Environment
Recently, I had the opportunity to sit down with three leaders in employee wellness who all utilize SDOH within their organizations – Jesse Gavin, Senior Wellness Manager at Baylor College of Medicine, Jeanette Martin, Vice President & Employee Wellness Manager at BankUnited, and Erica Miller, Vice President of Healthcare Strategies with Duley, Bolwar, and Pederson.
Below are key takeaways from the conversation.
Q: What comes to mind when you think of social determinants of health?
Jesse Gavin: Social determinants are basically anything outside of the interpersonal level that may affect a person’s individual health or wellness. I think health literacy and continued education are really important because if I hurt myself in March, but open enrollment information was provided back in October, I’m not going to remember what was said. The continued conversation and ability to communicate are key factors. I also think location and demographics play a huge role in health because here in Houston, we have access to plenty of healthy foods, but someone who lives in a rural or desert area may not have these same food options.
Erica Miller: I think social determinants of health are going to continue to become much more prevalent in this space and because of that, all benefits packages need to consider them for their populations. The most prominent determinants are the places in which we work, live, play, learn, and worship. If we are not designing appropriate benefits programs and analyzing the data to include those key pieces, then we are not meeting people where they are.
Jeanette Martin: Social determinants are what impact health more than anything else and are the relationships with those around us and the environment. The way we respond to and interact with our environmental factors – such as COVID-19, political issues, and social unrest – directly influence the state of our physical well-being. It is well-documented and supported in literature that a healthy state of mind positively impacts a healthy physical self. Regulating our exposure to negative messages greatly improves our state of mind, and social media is a major influencer in what drives our daily emotional state.
Q: Which of the categories of SDOH do you believe are most relevant?
Jesse Gavin: Sometimes it can almost seem like an impossible task to solve all of these issues for every person in your organization because everyone is so different. For one, we have a diverse population, and it is important that our employee-facing web portal has the ability to translate the information into other languages besides English. This allows us to address any language or communication barriers that may be in place. Additionally, we might have employees that are severely depressed, some are not worried about physical exercise, and some may be a single-parent household with three children and they can’t fit any more time into their schedule. Social determinants of health are very situational, which makes it very difficult.
Erica Miller: For a specific organization I work with, I would say that it is built around education, because I think the other determinants can be improved upon based on the levels of education and communication. They work diligently to ensure that there are a multitude of modalities, as everybody learns differently. They also take a blended approach and drip mechanism so that they are providing continual awareness year-round, and not just one topic at a time. Unless people feel comfortable and are well-informed of the programs, they won’t properly engage.
Jeanette Martin: I designed our wellness program based on 9 pillars of wellness that include: social, intellectual, occupational, spiritual, cultural, environmental, financial, physical, and emotional. Each of these areas of wellness makes up the big wellness picture of our lives. If any one area is seriously deficient, it will affect other areas of wellness. It’s important to recognize that the goal is not to achieve perfection in any one area, but to understand that finding balance is the key to harmony in life. Our program is designed to address public health concerns that are relevant right now, specifically within COVID-19 and the issues that come with it. These impacts are felt across all pillars of wellness, and it is important that we offer resources to make easy healthcare decisions and foster a sense of control over their environments.
Q: Is it more important to you to capture publicly available data across the entire member population, or to capture very specific data from a set number of individuals?
Jesse Gavin: When you think about which is most important, it depends – we are all different humans and we all have different needs. For example, our population at Baylor College of Medicine is fairly young, so we don’t see a ton of chronic conditions like heart disease or diabetes compared to the national standard. But from aggregate level data, we know the younger generation is more likely to have a wreck while texting and driving or risks more associated with those behaviors. So for us, it makes more sense to focus on issues like that. The ability to know your population and where they’re at in life is crucial in addressing wellness-related issues.
Erica Miller: From a consultant perspective, we spend a lot of time with individualized data. In order to help us be more granular in our approach, we look at the data from several different vendor partners that have helped open my eyes to the social vulnerability index. We can look at claims data in rural vs. urban areas or neighborhoods with high vs. low crime rates using ZIP code information. Additionally, we can access salary data, race and gender, and education levels to compare groups. We can then look at these populations’ health risks, chronic diseases, and comorbidities to identify trends. We are in the infancy of using the data to help drive and design benefits solutions. As we continue to progress, connecting the multitude of data points will be beneficial.
Jeanette Martin: It really is both because once we identify the trends, we can isolate what areas of priorities exist to better identify areas of concern and determine if programs can be designed and implemented to address those concerns.
For the data to be truly meaningful as it relates to building our program, the data has to come from local sources comparing companies like ours (industry and size). Nationwide generalizations are not always an accurate representation of health concerns in our geographic location. As it relates to our program’s success, the Florida Department of Health statistics that can identify trends in our geographic region, as well as our own internal claims analysis to identify population health trends.
Q: What are the challenges that you plan to use SDOH to help solve?
Jesse Gavin: With the pandemic, obviously, telehealth visits increased and there may be some perceived privacy concerns from the patient side. For example, if someone has mental health issues and they live in a one- or two-bedroom home with multiple other people, they may not feel comfortable talking with a mental healthcare provider virtually. Because of that, many issues go unaddressed. SDOH help us understand these differences in our populations and find alternate ways to engage them. The pandemic took a sense of connection, and with our younger population, many suffered from this feeling of isolation.
Erica Miller: We believe that how an individual interacts with their healthcare ecosystem will affect how they will engage in the workplace. I think it is important so that we understand our human capital management and how we can continue to improve upon the entire benefits package.
Additionally, even before the pandemic, isolation was one of the leading causes of depression. Now we have been forced into isolation and some of us were more capable of handling that than others. Some people lived alone and craved interaction, while others may be looking for ways to also influence their families at home. Considering these demographics is important in navigating health programming effectively.
Jeanette Martin: With the lingering COVID-19 virus and the Delta variant, concerns change dramatically and PCP visits are experiencing an impact as virtual visits increase. Risk can only be identified if there are trends validated by data. Therefore, we are working to gain understanding of the SDOH composition based on our program engagement and the analysis of claims data to identify high-cost patterns. As we better understand our population and their healthcare consumer habits, we can better appeal to their specific needs and address their concerns. Our wellness program partners with our dining facility and on-site fitness center to create a number of different educational seminars, challenges, and programs that are available to all employees both in person and virtually. With mental health being impacted heavily by the pandemic, we designed our EAP program to include apps and services to address these concerns. We also have a Licensed Mental Health Counselor and Psychologist on staff to host webinars and regular discussions.
About Jennifer Jones
Jennifer Jones, MSM RD, is an experienced healthcare professional with a background in clinical dietetics, wellness programming, and employer health. With over 20 years of experience, she has worked in various settings, including healthcare systems, occupational health organizations and health and welfare benefits advisory firms. After working directly with patients and employees, Jennifer joined Springbuk, where she serves as the Population Health Practice Leader, and turned her focus to population and employer health to achieve a greater impact on health outcomes.
