By Stan Smith, MBA, Senior Vice President – Sentinel Services, Prodigy Care Services
Over the last couple of decades, increasing attention has been paid to a group of factors known as Social Determinants of Health (SDOH). These impact healthcare delivery services and shape patient outcomes in all payer funding sources.
In workers’ comp, they can affect an injured workers’ response to treatment and result in hospital re-admissions and a higher utilization of healthcare services over the life of treatment.1,2,3,4,5 On a journey through the post-acute care (PAC) continuum, an injured worker interacts with multiple levels of healthcare services, as they move from long-term acute care hospitals to residential rehab, brain and spinal cord injury centers, skilled nursing facilities, and home healthcare.
According to the Centers for Disease Control and Prevention, “Social determinants of health (SDOH) are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.”2 The American Hospital Association, consistent with consensus among the broader healthcare community, cites these factors as, “Food, Housing, Transportation, Health Behaviors, Violence, Education, Social Support, Employment.” 3
For workers’ compensation patients needing PAC services, the potential impacts of SDOH look like the following:
- Food – the individual’s ability to easily access and prepare nutritious food and benefit from a stable diet or, when appropriate, meeting special dietary needs.2 Living in an urban or rural area with limited access to retail grocery stores can hinder the recovery of an injured worker receiving home health services after hospitalization. The ability to maintain minimal nutritional status to support recovery can be compromised. Here, creative case management can facilitate the injured worker’s ability to obtain and prepare nutritious food to foster their recovery at home.
- Housing – Here the focus is on the worker’s comp patient’s ability to live in an affordable, stable and safe home. Risks come into play if there are insufficient home care services, durable medical equipment or home modifications. Such circumstances may pose an immediate safety risk and cause the injured worker to question whether they can safely interact with their physical surroundings and deal with physical limitations related to the injury. Addressing an injured worker’s real and perceived needs for housing stability can prove critical in PAC home-based recovery.
- Transportation – The injured worker’s lack of vehicle access or their need to commute long distances to essential services like grocery stores, healthcare providers, along with employment are considerations. PAC recovery can be limited when people rely on assisted transportation from medical transport vendors or well-intentioned family members and friends.2,4,5 Therefore, it is prudent make sure the injured worker has effective transportation in place before returning home. If distance is an impediment, provide as many services as possible with fewer transportation events.
- Health Behaviors – These can impact an injured worker across the entire healthcare delivery experience. They are typically taken to mean the individual choices and resulting behaviors displayed by a patient and caused by the experiential lens of that person’s socio-economic factors and related life circumstances. An example can be something as simple as an injured worker who finds themselves receiving complex inpatient rehabilitation services in a rehab facility. Their life socialization may have resulted in either little respect for people perceived as authority figures or, at the opposite end of the spectrum, being overly deferential to same. Consequently, the individual may be resistive or non-compliant with treatment. On the other hand, they could be overly deferential and unwilling to self-advocate as their care continues. Recognizing these potential factors allows healthcare providers and other workers’ compensation stakeholders to advocate with the injured worker in interactions with their PAC healthcare team as services are effectively delivered.2,3,4,5,7
- Violence – When an injured worker’s PAC recovery occurs in proximity to violence risks, such as violence by weapons, intimate partner, robbery and theft, child abuse, and/or environmental high crime incidence, the person’s ability to meaningfully engage with healthcare providers will be severely limited. The patient’s access to healthcare professionals can open a communication channel to protective services intervention focused on lessening or eliminating these risks. Incorporating an SDOH screening tool that prompts the injured worker to self-disclose these risks can be an effective first step to mitigate violence factor risk.3,4
- Education, Income, Employment, and Social Support – In SDOH risk analysis these four factors can be interrelated.2,3,4,6 When an injured worker has a social history of lower education and income, unstable employment and few supportive social relationships, their likelihood for successful treatment outcomes tends to be lower than those whose social history represents higher levels of these elements. SDOH proponents believe there is a predisposition to poorer outcomes when these factors have low magnitude.2,3,4,5 Therefore, when providers and other stakeholders are aware of these issues, they should provide the injured worker an advocacy safety net to aide them in engaging their PAC healthcare providers.
Employers have been aware of SDOH issues since at least the 19th century and The Affordable Care Act put a spotlight on their effects on health and recovery. Workers’ compensation stakeholders will benefit from developing policies and programs to address them. My colleague, Matthew Imes, the President and Co-Founder Prodigy Care Services and former Chief Strategy Officer Adva-Net Ancillary Networks has this to say about them: “From my perspective as a former comp claims adjuster and executive developing workers’ comp managed care delivery solutions, our industry needs to explore SDOH principles and incorporate them into the overall continuum of healthcare delivery, including the complex sleeve of post-acute care,” he said. “This will be critical to continuing to do right by our nation’s injured workers.”
Notes
1“Health Care Steps Up to Social Determinants of Health: Current Context”, Solomon, Loel S, PhD, MPP, Kanter, Michael H, M.D., Permante Journal 2018;22:18-139E-pub: 10/22/2018 https://doi.org/10.7812/TPP/18-139
2“Social Determinants of Health”, www.cdc.gov/publichealthgateway/sdoh, Centers for Disease Control and Prevention, September 2023, www.cdc.gov
3“Social Determinants of Health”, www.aha.org/social-determinants-health/populationcommunity-health/community-partnerships, American Hospital Association, 2024, www.aha.org
4“Social Determinants of Health”, www.aha.org/social-determinants-health/populationcommunity-health/community-partnerships, American Hospital Association, 2024, www.aha.org
5Burke, Robert E., MD, MS, Whitfield, Emily A., PhD, Hittle, David, PhD, Min, Sung-joon, PhD, Levy, Cari, MD, PhD, Prochazka, Allan V., MD, MSc, Coleman, Eric A., MD, MPH, Schwarz, Robert, MD, and Ginde, Adit A., MD, MPH, “Hospital readmission from post-acute care facilities: risk factors, timing, and outcomes”, J Am Med Dir Assoc. 2016 Mar 1; 17(3): 249–255.
Published online 2015 Dec 20. doi: 10.1016/j.jamda.2015.11.005
6Bussells, Aditi Srivastav, Ph.D., Gewurz, Danielle, M.S., Balsky, Tanya, M.P.P., Maskut, Jessica, Ph.D., Khau, Meagan, M.H.A., “Relationship Between Post-Acute Care Setting, Social Determinants of Health, and Hospital Readmission Rates”, ww.cms.gov/files/document/relationship-between-post-acute-care-setting-social-determinants-health-and-hospital-readmission.pdf, June 2023.
7Colvin, Wendie, M.S.N., R.N., “Stereotypes and Social Determinants of Health: 5 Steps to Deal with Conscious and Unconscious Bias in Post-Acute Care”, Home Care Pulse, www.homecarepulse.com/articles/stereotypes-and-social-determinants-of-health-5-steps-to-deal-with-conscious-and-unconscious-bias-in-post-acute-care, March 2023.
About Stan Smith
As Senior Vice President of Sentinel Services, Stan Smith develops and oversees Prodigy’s innovative and proprietary specialty services focused on post-acute care, acute and ambulatory care cost containment and supporting the growth of ProdigyRx, the company’s PBM.
Smith has over 30 years of executive leadership experience in healthcare administration with inpatient rehabilitation and long-term acute care hospitals, skilled nursing facilities, rehab centers specializing in traumatic brain and spinal cord injuries, and psychiatric and addiction centers. Additionally, he has developed acute and ambulatory care cost containment services and a specialty healthcare provider network for catastrophic workers’ compensation injuries.
Smith has presented at several national conferences and published articles in a variety of healthcare admin topics, including catastrophic care management, acute – post acute care discharge management, post-acute care traumatic/acquired brain injury treatment, and quality assurance.
He holds a Master of Business Administration / Healthcare Administration degree from the University of Dallas, is a licensed long term care administrator and can be reached at ssmith@prodigyrx.com.
About Prodigy Care Services
Based in Austin, Texas and founded in 2020, Prodigy Care Services is a healthcare services technology company dedicated to positively impacting the lives of workers’ compensation patients by delivering outcomes-driven care solutions and increasing payer efficiency across the continuum of care. It provides services nationally to insurers, third-party administrators, bill review and case management companies, and other workers’ comp payers. PACparency along with the ProdigyRx pharmacy benefit manager, proactive clinical controls, and a suite of evidence-based, patient-centric clinical programs and tools are among Prodigy’s offerings. For more information, please see www.prodigycareservices.com or call (713) 322-6667.