Clinicians know that every patient in their care is unique. There are many medical and nonmedical factors at play that can influence someone’s health and ultimately impact the types and levels of care they’ll need. Health experts and regulators are constantly striving to better understand these factors and intersectional qualities, and lately they’ve done so with a renewed focus on health equity.

In early 2022, Centers for Medicare and Medicaid Services (CMS) announced new requirements for screening on social determinants of health (SDOH) beginning in 2023. This announcement follows years of data showing that a patient’s social status and support levels can have significant impacts on their health, and CMS is working to analyze data on social risk factors in patient populations and inform hospital systems on how best to serve those in their care. 

In addition, the Healthcare Effectiveness Data and Information Set (HEDIS), which is used by almost all U.S. health plans to track healthcare performance, this year began requiring  HEDIS plans to track SDOH as well through a new Social Need Screening and Intervention (SNS) measure.

Here’s what hospitals and health professionals need to know to abide by these new requirements. 

Understanding the SDOH reporting requirements

The changes require hospital systems to screen all adults aged 18 and older for social determinants of health (SDOH), which include questions around the health and safety of their home environment, their food security, economic stability, and more items outlined below. These requirements allow CMS to better understand what social risk factors are actively influencing the patient population and just how many individuals are impacted. Current estimates show that SDOH factors can influence up to 80% of total health outcomes.

To gain key insights into the patient population, health professionals are expected to look at two new metrics as a part of Inpatient Quality Reporting (IQR)—SDOH-1 and SDOH-2.

What is SDOH-1?

SDOH-1 is a measurement designed to track the new screenings themselves. With this number, hospitals will report the number of patients who are actively screened for relevant social risk factors, as outlined in SDOH-2.

The tracking for SDOH-1 should be applied to all patients aged 18 or older. Patients may refuse screening, which is an allowed exception. The goal is to document how many patients are being screened compared to the total eligible patient population, so both numbers must be tracked.

What is SDOH-2?

While SDOH-1 aims to track the screenings themselves, SDOH-2 is designed to track the presence of social risk factors. At this time, CMS requirements are looking for five critical risk factors, including:

• Interpersonal safety
• Food insecurity
• Housing insecurity
• Utility insecurity
• Access to transportation

The criteria for SDOH-2 are directly related to essential social drivers of health. In this case, the goal is to track whether patients have access to safe living environments and everyday essentials.

We know that these factors can influence adult health in many ways. Existing data offers several examples, including:

• Mothers experiencing food insecurity report three times as many oral health problems as those who have adequate access to food.
• 58% of patients without access to transportation said they would be unable to attend an appointment and receive essential medical treatments without assistance.
• Homeless patients given access to housing support experience 2.6 fewer hospitalizations on average.

By collecting this information, both CMS and the healthcare community as a whole can learn more about the direct impacts of these risks and how to best navigate them.

Why are these SDOH reporting requirements being made?

With a renewed societal focus on health equity comes moral responsibility. Since social risk factors can drastically influence patient health, these changes are designed to turn data into actionable change at scale.

As more hospitals keep a record of how these factors affect their patient populations, we will gain a stronger understanding of the core factors at play — and how many patients are at risk. Over time, this information can help us better understand and accommodate patients and ultimately allow clinicians to provide more comprehensive care and support.

What do these SDOH reporting requirements mean for hospitals? 

All reporting is voluntary for 2023, but will be mandatory in 2024. In the meantime, health systems are strongly encouraged to define appropriate internal processes and begin reporting. Using 2023 to ease into this transition will support successful reporting in future years.

Hospitals are being given freedom to navigate these changes, allowing every team to collect data on their own terms. However, CMS guidelines make it easy to ensure accurate and effective reporting. Submission deadlines are expected to follow existing reporting schedules, which means data must be submitted by May 15 of each following year. 

Although CMS allows hospitals to manage their own reporting process, it has provided a breakdown to help define the process. The reporting itself must be uploaded using the Hospital Quality Reporting (HQR) system online. Hospitals looking for additional support to facilitate this change may also be eligible for grants.

As systems prepare to meet these requirements, some helpful guiding questions to begin considering internally include:

• How is your health system currently addressing SDOH collection?
• What plans are in place to meet CMS requirements ?
• What percentage of inpatients are you reaching with current efforts? 

How can digital patient engagement help you meet the SDOH reporting requirements  

SDOH screening collection is layered. It can be manual and cumbersome for care teams and feel invasive for some patients. Plus, clinicians are not often equipped to connect patients with community-based organizations to help meet needs uncovered in screening. In order to enhance the experience for both groups, hospitals should consider onboarding a screening solution at scale. 

GetWell Inpatient is a digital patient engagement solution helping patients and clinicians connect through multimodal devices inside and outside of care settings. The solution includes SDOH screening and provides a comprehensive, diverse set of patient education tools that drive value and meet patient needs. 

Simplified screening for SDOH, however, is only half of the story. Providers must be equipped to help their patients find resources for gaps uncovered in their screenings. Add-on services to GetWell Inpatient including GetWell Navigate can meet that need. 

GetWell Navigate automatically scans patients’ SDOH responses and develops automated matches to resources and benefits. This solution operates through SMS text outreach backed by curated, highly-trained community-based virtual navigators who build trust and engagement with all patients. With these invaluable, tech-supported human interactions, we can help ensure vulnerable populations don’t fall through the cracks. 

Bottom line

Providing exceptional patient care is every clinician and health system’s goal. These screening requirements will play a key role in supporting health equity and helping systems better understand and support the populations they serve. 

To be successful, health professionals should follow the recommended collection guidelines and start reporting this year. Focusing on asking the right questions, getting teams up to speed, updating necessary forms, and opening a dialogue with patients will help to ease this transition. 

In addition to early-adoption, clinicians and health systems should seek out trusted technology partners to help ease internal processes and ensure holistic patient needs are met with every visit. 

The changes we make today can drastically improve public health tomorrow.

Learn how you can leverage GetWell’s Inpatient to collect SDOH data, helping you meet CMS and other reporting requirements at scale in this webinar.