Path to Prioritizing SDoH in Whole Person Chronic Care: Q&A series featuring Dr. Javier La Fontaine, Dean & Professor, UTRGV School of Podiatric Medic

To successfully implement a social determinant of health (#SDoH )-first approach to #healthcare , it's essential to prioritize a patient-centered experience. This involves a collaborative effort from multiple care providers who can account for any obstacles in managing #chronicdiseases . In this installment of this SDoH Q&A series, we're discussing this crucial topic with an expert: Dr. Javier La Fontaine , D.P.M., M.S., M.Ed., the Dean and Professor of The University of Texas Rio Grande Valley School of Podiatric Medicine.

He provides insights into how clinicians have deeper, meaningful conversations that help better understand the patient and his or her needs, how payors can add valuable support that complements the efforts of primary care providers and specialists, and more.

Q: What should clinicians be asking their patients living with chronic conditions to better understand the challenges they are facing specific to social determinants of health?

Clinicians are educated and trained to always collect information about what we call “social history.” Nonetheless, SDoH goes further than that. For instance, one of the prescribed questions we always ask is how much and how long the patient has smoked. The goal is to make the connection that if a patient smokes, he/she might have coronary artery disease. However, we are not taught to ask “why” the patient continues to smoke, as well as the obstacles the patient may experience in quitting smoking. Clinicians need to go one to two layers deeper to not only gather critical information from the patient that maps to risk but also to understand the “why” behind the patient’s choices and decisions.

Q: Are there any approaches your organization or other leading organizations in healthcare are taking to prioritize SDoH needs for people living with chronic diseases?

The UTRGV School of Podiatric Medicine (SOPM) is taking a unique approach to establishing itself as a member of the community in the Rio Grande Valley. We intentionally placed the school in a diverse area to support two specific SDoH challenges. One is access to quality, affordable care for patients. By placing the school in the community, people can more easily access high-quality podiatry services in their own “backyard.”?

Second, the school location has also improved the diversity of our student population and the diversity of our future podiatrists. For many patients, there is high value and trust in being able to see a clinician for care who shares their own cultural background.

Q: What should an SDoH-first approach to care actually look and feel like for a patient?

A: SDoH should feel “patient-centered.” Patients need to feel that all the obstacles that might impede the management of their chronic disease are being accounted for. Many of these obstacles vary — from financial, access to care, potential loss of job, family and cultural issues, and others. This creates challenges, as no one clinician can address these issues. Therefore, an interdisciplinary approach is ideal where the clinician and sub-specialists — such as a social worker, care manager, and nurse navigator — work together to discuss, access, collaborate, and solve each obstacle alongside the patient.

Q: How can patients best communicate their SDoH needs to their care providers?

A: I do not think there is one correct way to do this. There are many cultural barriers that may play a role in how a patient will communicate with their provider. The simplest form of communication is face-to-face with the provider. However, as an example, in a case where alcohol is impacting a patient’s diabetes, that patient might be more comfortable discussing this personal challenge with their social worker instead of their physician. The structure and the “caring” environment need to be present, so the patient is encouraged to communicate with the interdisciplinary team.

Q: If a person isn’t receiving the care they need related to SDoH, where else can she or he go for support beyond a primary care provider and/or team of care specialists?

A. First, if the patient is insured, he/she should start with the insurance company. A conversation with the insurer can help the patient better understand what programs and services may be available to support their SDoH challenges so that patients can then better communicate and coordinate with their care team.?

Second, based on the cultural environment where the care is given, the community can be involved. For example, in the Rio Grande Valley, there is a community outreach program that involves “promotores(as).” This program hires community members and sends them to patients’ homes. Their job is to ask each patient questions such as, “Are you taking your medication?”; “Have you seen your doctor?”; “What have you done to stop smoking?”; and more. This program can help identify gaps in the care of a patient.

Q: When clinicians are more overburdened than ever, how can they best prioritize SDoH in the shortened care visit of today — and beyond?

A: The private practitioner will continue to struggle because insurance does not reimburse coordination of care. Unless insurance companies take it upon themselves to provide a strong SDoH foundation for the practitioner,?SDoH simply won’t be a top priority because there is not enough time or resources in traditional models of patient care. The practitioners in large groups, or hospital groups, often may have a better solution, as they can collaborate with broader, more integrated teams that are better resources to support SDoH challenges.?

Q: What innovations specific to SDoH do you think hold the greatest promise today and in the next five years??

A: Telehealth is a big step toward positively addressing SDoH. It helps improve access to care, especially when dealing with chronic diseases where SDoH challenges often run rampant. Telehealth also helps optimize the use of ancillary staff to maintain an open line of communication with patients, so they can receive more real-time guidance and coaching from their homes.