Many health systems have discussed the role they can play in addressing social determinants of health (“SDOH”), yet by February 2020, only a reported 9.1% of health systems had announced a plan to invest in SDOH. A plan is essential to create meaningful change and to define measurable goals in SDOH. As health systems look for concrete steps to take in addressing SDOH, below are some common areas where systems have focused their efforts in recent years.
- Housing
One of the most common investments made by health systems to address SDOH is in affordable housing. Last year, The MetroHealth System announced a $60 million plan to build approximately 250 apartment units near its main campus. That project includes 72 affordable housing units, and up to 190 more will be at market rate. The project is a part of MetroHealth System’s $1 billion plan to build an 11-story, 264-bed hospital financed largely by hospital-revenue bonds.
Why is affordable housing important to the community? Research has shown that low-quality housing can lead to chronic disease, injury and poor mental health. Providing an opportunity for community members earning between 30% and 80% of the area’s median income to find quality housing has been shown to directly impact physical and mental health of the residents. Affordable housing has been found to decrease health care expenditures by 12% for Medicaid recipients and 18% in costly emergency department visits. Investment in affordable housing effectively reduces uninsured visits in hospitals, opening up funds to support similar projects in the future.
- Transportation
Several health systems have begun partnering with ride-share services, such as Lyft and Uber, to remove transportation as a barrier to health care. Uber has partnered with Cerner, a health information technology company, to allow health care providers to easily schedule non-urgent transportation for patients, caregivers and staff. MedStar Health, a member of the Cerner network, has implemented a transportation plan and seen an increase in patient visits, as much as 5-10 percentage points in some practices, leading to increased revenue.
Some health systems have focused on transportation strategies, as opposed to affordable housing, because they are easier to implement and the cost is typically lower when compared to capital-intensive strategies like affordable housing. Lyft and Uber are providing the services, keeping capital investment low and more health insurance policies are starting to cover ride-sharing services.
- Food Security
Harris Health System has taken action to help increase access to nutritious food. More specifically, the Lyndon B. Johnson Hospital in Houston, Texas, has developed a small farm to grow fresh vegetables which it donates to patients. The Hospital has also used the farm to host programming about produce, healthy eating and wellness. With plans to convert rooftops into green spaces, there is potential to eventually supply the Hospital cafeteria with fresh produce.
Investing in local farms and facilitating access to nutritious foods will help people build healthy eating habits, which can help reduce or eliminate a number of health-related conditions. Lyft has also started a Grocery Access Program to offer low-cost rides to people who struggle to find transportation to a store with fresh produce. The challenge is not so much informing patients on what to eat, but connecting them to the resources necessary for healthy meals.
- Employment
Johns Hopkins University and Johns Hopkins Medicine have invested in career opportunity initiatives for more than a decade. In 2004, Hopkins started with a program to enhance the skills of existing employees to fill high-need positions. In 2015, the University and Health System launched HopkinsLocal – an initiative to support economic growth, employment and investment in Baltimore. The program launched with the goal to have 40% of new hires come from selected Baltimore zip codes by 2018. In 2020, HopkinsLocal increased this goal to 50%. The program also sets priorities for local vendors, with a goal to increase spending with Baltimore businesses by $25 million.
Prioritizing local and minority-owned suppliers can help create jobs in the community. Well‑paying jobs bring health insurance which encourages more preventative care. The Democracy Collaborative has developed a toolkit for exploring other case studies on employment initiatives and how different strategies can benefit the communities hospitals serve.
- Education
In 2019, a California health system announced more than $20 million in grants for several organizations that focus on addressing health outcomes on a community level. One recipient of the grant funding was the Workforce Development Council of Seattle-King County (“WDC”), a nonprofit organization that oversees employment-related programs for youth, the adult workforce and employers in the Seattle and King County region. The grant funding will help the WDC develop a program providing targeted training with placements in manufacturing and health care for the 20,000, 16 to 24-year-olds in South King County who are not in school or working.
Education can impact the other social determinants of health as it often leads to jobs with higher wages for housing, transportation and access to healthier foods. By investing in opportunities for students from low-income backgrounds whose education systems has historically left them unprepared for the workforce, health systems can help young people escape the cycle of poverty.
If you have any questions or would like additional information, please contact:
- Andrew Dick at (317) 977-1491 or adick@wp.hallrender.com;
- Matt Paradiso at (248) 457-7844 or mparadiso@wp.hallrender.com;
- Gerard Faulkner at (214) 615-2036 or gfaulkner@wp.hallrender.com; or
- Your regular Hall Render attorney.
Special thanks to Ben Jamison for his assistance with preparing this article.
Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot—outside of an attorney-client relationship—answer specific questions that would be legal advice.
