There is growing consensus among health care providers that the health care system must do a better job of recognizing and addressing patients’ social circumstances and needs. Addressing the social needs of acute care “super-utilizers”—patients who consume a large share of health care resources with frequent emergency department (ED) visits or hospitalizations—has been a particular focus in this context. According to a 2012 study, just 1 percent of the population accounted for 20 percent of annual health care spending. In the Medicaid population, this pattern is even more pronounced, with about 5 percent of beneficiaries driving more than half of total expenditures.
Research suggests that combined medical and social complexity drives the health care use of super-utilizer patients. The social complexity experienced by these patients primarily refers to challenges associated with social determinants of health (SDOH)—the conditions in which people “are born, grow, work, live, and age”; and the broader systems that shape the conditions of daily life. Because super-utilizers rely heavily on emergency medical services (EMS) and EDs, acute care settings have been considered as sites for screening for social needs in this population. In spite of SDOH needs accounting for nearly one-third of annual deaths in the United States, the literature around the effectiveness of screening for and addressing SDOH needs in these acute care settings is mixed.
Until an expanded evidence base is available, it is unclear whether SDOH screening in acute care settings is a silver bullet—as some claim—or a tool gaining momentum with few indications that it is effective at improving the social circumstances or health of high-need patients.
Author(s): Mahshid Abir, Stuart Hammond, Samantha Iovan, Paula M. Lantz