SDOH Data Collection – Gaps and Opportunities

It is no brainer for common understanding but yet it took significant global researches to prove human economic and living conditions have direct impact on healthcare utilization and engagement. As this understanding has profound impact on Medicaid and Medicare expenditures and therefore swiftly made inroads into healthcare policy making and eventually into CMS and HHS program manuals for policy operationalization. Consequently, revised guidelines of various measure stewards such as NCQA HEDIS?, CMS MA Stars, MIPS, PQRS, CMS HCC Risk are pushing both payer and provider enterprises to gather social demographic data for each covered member/patient and engage wide range of analytics to determine focused intervention strategies. Everyone acknowledges this need of the hour and a lot has been written on this subject. Yet stakeholders are grappling to gather and engage social demographic data. Let us understand practical aspects behind SDOH data collection through #1SF schematic given with this article.

·??8 key socio-demographic data include Sex, Geography, Language, Disability Status, Income, Race/Ethnicity, Sexual Orientation and Gender Identity (SOGI).

·??These variables are spread across 12+ sources (refer #1SF schematic) of varied degree of completeness and maturity.

·???Many socio-demographic variables are optional fields at the point of collection such as plan enrolment, patient registration. This was done purposefully to avoid bias or differential treatment during initial inclusion but in current situation they play a major deterrent in social-demographic data collection. Regulatory changes are desired to bring in an unified code for social-demographic data collection at the point of entry.

·???Many plans and providers are now employing self-reported surveys through portal/app to gather socio-demographic information. Due to lack of awareness on social data usage amongst member population, success rate of such initiatives is often not encouraging.

·???There is no industry golden standard data model for implementing socio-demographic data. The closest reference is “2011 HHS Implementation Guidance on Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status”.

·???Regulatory program, population health management, care management, risk management have diversified requirements for collecting socio-demographic data. Payer and provider enterprises need to incorporate a holistic data model encapsulating all program requirements. An industry standard is a must prescribed here.

·???Though USCDI 4.0 and USCDI 5.0 specifications have expanded to incorporate socio-demographic variables which would facilitate seamless exchange of social data between payer-provider and vice versa, the original problem of securing social data would continue to persist for sometime till all allied internal and external systems are interconnected and interoperable.

#CMSMAStars #SDOH #SocialDeterminantsofHealth #SocialRiskFactors #MemberExpereince #USCDI #FHIR #NCQAHEDIS #CMSHCCRISK #Sociodemographicdata

1SF Background- Taking advantage of my industry experience while working with wide variety of healthcare problems, shaped 1-Slider-Fox (#1SF) an initiative to uncover some of the complex business problems and situations prevailing in US healthcare. 1-Slider-Fox distinctly breaks down the problems for common understanding with simple flows and visualizations within “One Slide”.? Through #1SF, I look forward to bring series of such business problem explanations pertaining to US payer/payvider in future.

Disclaimer – The content presented through 1SF is my own original creation and includes my own personal viewpoint. This has no bearing whatsoever on my present or past employment.? – Prosenjit Dhar (Pro)