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

IMPLEMENTING SDOH SCREENINGS: WHICH ONES? 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

Audience Poll Slido.com #SDOHscreenings To what type of organization or profession do you belong? You are….  Academic or Research  Payer  Health System or Provider  Vendors  Policy/Government  Other?

Comprehensive Social Need Screening Channel Test 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 tools evaluated  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

Audience Poll Slido.com #SDOHscreenings  What types of populations are you serving or studying?  Seniors  Working age adults  Pediatric  Specific condition, situation or need-based?

Social Risk Screening in Healthcare: State of the Science Caroline Fichtenberg, PhD Social Interventions Research and Evaluation Network (SIREN) University of California, San Francisco February 10, 2010 Datapalooza

92% Hospitals Practices 67% Prevalence of screening for social risk factors in US Health Care 24% Orgs 16% Screen for at least 1 social Screen for all 5 social risks risk 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? 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 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.

Question wording matters 150% HVS (often, 96% 94% 93% 91% 100% sometimes, 83% 82% 76% 72% never response 50% options) Gold standard: 6-item 0% Household Food Security Sensitivity Specificity Sensitivity Specificity Screen 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.

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

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) Screened positive 100% Screened negative 80% Interest in Assistance 60% 40% 37% 35% 35% 40% 20% 11% 8% 8% 4% 5% 2% 0% Housing Food Utilities Transportation Personal safety From De Marchis E. North American Primary Care Research Group Annual Meeting. 2019.

No standard tool yet Patient acceptability of screening is high Where does this leave us? 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

Audience Poll Slido.com #SDOHscreenings 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

DEVELOPING A SENIOR- SPECIFIC SOCIAL NEEDS SCREENER Jessa (Engelberg) Anderson, PhD Prior affiliation: West Health Institute Current affiliation: ServiceNow

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 o Pre-testing o Patient Family Advisory Committee  Applied feedback to modify

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

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

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 o No standardized screening for social needs o Concerned with logistics o 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 o Patient-reported o Utilization data o Screening rates  Qualitative o Interviews o 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 3.16 .035 1.09, 9.18 >1 social needs Likelihood of having one or more ED visits in the prior 6 months (n=170) Odds Ratio p-value 95% CI Screened Positive for 2.09 .088 0.90, 4.89 >1 social needs Controlled for sex, race/ethnicity, age, number of chronic conditions

Scaling and Spreading  Sustain at the SeniorHealth Center o Use workflows with complex ACO patients o Medicare Annual Wellness Visit template and incorporate into EHR  Spread o UCSD adopting Annual Wellness Visit template  Scale o Humana testing o Practical Guide to Addressing the Social Needs of Older Adults • Available to download here

Clare Tanner, PhD Health Datapalooza, February 10, 2020 Perspectives from systems, clinics, providers, payers, nonprofits

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 Build local capacity Policy & Systems Change Build the Build the Evidence Movement Base DA TA A CROSS SECTORS FOR HEA LTH DA SHCONNECT.ORG A LL IN: DA TA FOR COMMUNITY HEA LTH A LLINDA TA .ORG