By KARLY ROWE, Experian Health


The stats are alarming: up to 80 percent of health outcomes, according to a survey by The Physicians Foundation, are not due to medical factors, but to a patient’s social and economic circumstances – such as their income, housing situation and even whether they own a car. In fact, a study by Eskenazi Health conducted among 500 patients revealed approximately 2 out of 3 were affected by at least one social determinant of health (SDOH).

The healthcare industry has been talking about the importance of addressing SDOH for years, but many struggle with how to collect the insights. For example, if 68 percent of Americans are affected by at least one SDOH, but how do they even discover the one? What is the ideal way for providers to screen for SDOH?

Patient surveys can be a useful way to find out about many potential barriers to care. However, they bring limitations:

  • Your insights will be limited to the patients who show up – so anyone who has struggled to attend an appointment (and therefore potentially has higher needs) will be left out.
  • It can be time-consuming and expensive to give staff the time and space to conduct personal interviews.
  • They rely on patients to be willing to share openly, but some may not feel comfortable doing so.
  • There is room for error in how questions and answers are interpreted by both the survey team and respondents.
  • Social circumstances can change over time, so it’s possible that the information gleaned in the survey might not be relevant a few months down the line.

Knowing SDOH can have such a huge impact on a patient’s health certainly means clinicians should discuss these topics in the exam room but relying solely on patient surveys and conversations could lead to gaps in intelligence. Screening for social needs when a patient first registers or engages with your services is a good starting point, but their situation could change between diagnosis and treatment.

This is where technology comes in. The real predictive power of SDOH data comes when you combine patient-specific information obtained through screening with consumer data. A third-party vendor can help you access data on your patient population’s income, occupations, length of residence and other social and economic circumstances. When reported or displayed in an actionable way, your care managers can use this to inform proactive, preventative engagement with patients to solve non-clinical gaps in care that are leading to readmissions, excessive ED utilization and other negative health events.

If you are leveraging SDOH, a few things to consider to maximize the benefits are the following:

  • Scalability — you will want to leverage multiple data points to flag patients at high risk of the leading social determinants of health and coordinate referrals to community programs.
  • Standardization — be sure to eliminate the variation that comes with surveys and have the same consistent set of social indicators on every patient on your roster so that no one slips through the cracks.
  • Interoperability — integrating data and actionable insights with a universal patient identifier and care management tools will allow you to make sure that all information is tied to an accurate patient record that follows them throughout their patient journey.
  • Actionable — providing your team relevant and actionable insights as part of the standardized set of information on each patient to not only understand that there is a need … but also understand what is driving that need and address the barriers to the care.
  • Reliable — you should feel confidence in the accuracy and integrity of your data and working with an original-source compiler means you’ll know with certainty your data is from a verifiable source and collected in line with consumer privacy best practices, such as the General Data Protection Regulation (GDPR) and the California Consumer Privacy Act 2018 (CCPA).

There is plenty to discuss in terms of when and how to utilize SDOH; but when organizations are ready, the technology is here. It’s up to each provider to develop a strategy and integrated effort to ensure that the data leads to actionable steps and better patient outcomes.

Apr.Rowe.Karly Rowe HeadshotKarly Rowe is Vice President, New Product Development, Care & Identity Management at Experian Health, which offers digital engagement strategies and solutions across the healthcare journey – including patient engagement, revenue cycle management, identity management, care management and analytics. For more information, go online to







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