SDOH Screening for Employees | Highmark Health Research Institute

Social determinants of health (SDOH) encompass the conditions in which someone lives, works, plays, learns, worships and receives health care. SDOH define 80% of a person’s health outcomes. Understanding SDOH data can help providers, payers, and policymakers better understand the health needs of groups, communities and individuals.

What are social determinants of health?

The U.S. Office of Disease Prevention and Health Promotion¹ defines SDOH across five essential segments of life:

• Financial stability provides for safe housing, healthy food, and transportation.
• Neighborhood defines quality of life measures like violence, racism, discrimination, technology resources, toxic pollutants, and other aspects of the built environment.
• Community speaks to the connections that a person has with family, friends, work, church, health care providers, and affinity groups.
• Access to quality education sets the stage for a lifetime of success and enables health literacy.
• Access to quality health care makes it easier to receive primary and preventive care, as well as chronic disease treatment.
  

At Highmark, identifying and addressing SDOH among our members is integral to our Living Health strategy. Understanding the root causes of poor health and chronic disease helps us improve health equity for better outcomes.

SDOH screening and assessment study

Highmark Health Research Institute² investigated the difference between publicly available SDOH data and self-reported SDOH data. Publicly available data reflects the Social Vulnerability Index (SVI), which calculates risk of harm based on census findings. 

SVI includes socioeconomic, household, racial, ethnic, housing, and transportation data as evaluated across geographic areas. The greater the SVI, the greater the risk in the community. Conversely, self-reported data comes from an individual. 

Working with Allegheny Health Network (AHN), we coordinated SDOH screening as a regular part of patient care. This effort ensured that data was accurately self-reported, documented, and available to caregivers, case workers, and researchers.

Screening included questions about:

• Financial resource strain over the past 12 months.
• Food insecurity due to lack of funds.
• Health literacy and ability to understand physician and pharmacy information.
• Housing stability and having a secure place to live.
• Safety in one’s neighborhood and fear of known persons.
• Social connections, companionship, loneliness, and isolation.
• Transportation needed for work, personal needs, and health care visits.

The study culminated in 841,874 SDOH assessments with 401,697 different individuals aged 41 – 70, primarily in an AHN clinical setting. Researchers aggregated the self-reported data and compared it to the SVI data. Findings showed that:

• 70% of individuals in the study were white
• 55% were female
• 14.3% had unmet SDOH needs
• 6.6% reported financial difficulties
• 4% reported housing instability
• 35% of people with SDOH needs lived in high-SVI areas
• 24.9% with no SDOH needs resided in low-SVI areas

Researchers concluded that self-reported financial resource strain, food insecurity, transportation, and safety data correlated across high-SVI areas. Lack of health literacy and social connections appeared across all communities on the SVI spectrum.

Socioeconomic, racial, and ethnic factors played directly into higher SDOH needs. Socioeconomic status was the single most defining factor, associated with 300% higher incidence of SDOH concerns.

SDOH self-assessment for improved employee health

Social vulnerability measures can give your company a better understanding of prevailing conditions among employees in a specific location. However, a formal self-assessment program will capture SDOH details at the individual level.

Researchers believe that person-level data overlayed with SVI data allows for better clinical outcomes and greater health equity. Encouraging employee self-assessment can help uncover SDOH needs that would otherwise remain hidden. All Highmark members have online access to an SDOH screening tool with core questions³. 

Once a member identifies an SDOH need, case workers and network providers can offer a solution. Members can connect with community resources like food pantries, housing assistance, financial support, childcare, and transportation services.

Highmark can also look at shared needs across an employee population and present employers with recommendations such as easier health care access, health literacy programs, food and nutrition, financial counseling, and/or transportation benefits for commuters.

Self-reported SDOH data makes it possible to remove quality of life obstacles that impact employee health, productivity, and presenteeism. Read more in these supporting articles:

Social Determinants of Health

Social Determinants of Health in the Workplace