Introduction to Social Determinants of Health (SDOH) Screening Tools

Background on SDOH Screening Tools

The five social determinants of health (SDOH) are universally recognized as critical factors influencing member health outcomes. As healthcare spending continues to rise, finding alternative ways to cut costs has been top of mind for health plans. There has been a shift towards improving overall health, and promoting preventative care, as a measure to save costs. After all, a healthier member population equates to less reactive, oftentimes less costly, healthcare spend.

Social determinants of health encompass a wide range of factors, including where people grow up, their education level, and income. It is well-studied that these elements have a more profound impact on health than genetics or access to healthcare services alone. Health plans that recognize and address they key indicators early on, can more effectively:

1. Identify potential health risks before they escalate
2. Develop targeted interventions tailored to individual member needs
3. Promote proactive health maintenance strategies
4. Enhance overall member well-being

Similarly, health plans that adopt a more comprehensive approach to healthcare delivery stand to improve member health outcomes as well as generate significant long-term cost savings. A proactive approach to screening SDOH has helped health plans:

1. Reduce the frequency of emergency room visits and hospitalizations
2. Improve medication adherence and chronic disease management
3. Increase participation in preventative care services
4. Enhance member engagement and satisfaction with their healthcare experience

New CMS Rules

The Centers for Medicare & Medicaid Services (CMS) is expanding its focus on Social Determinants of Health (SDOH) screenings across health care settings. This initiative aims to provide more comprehensive and equitable care to plan members and address factors that significantly impact health outcomes. 

Starting January 1, 2024, CMS requires SDOH screenings for all inpatient hospital admissions. These screenings must cover five specific domains: food insecurity, housing insecurity, transportation needs, utility difficulties, and interpersonal safety. Hospitals must report the screening results by May 15, 2025.

In addition to inpatient requirements, CMS has recently announced plans to extend SDOH screenings to outpatient settings, with voluntary reporting in 2025 and mandatory reporting beginning in 2026. This expansion will include various clinical settings such as Hospital Outpatient Departments (HOPDs), Rural Emergency Hospitals (REHs), and Ambulatory Surgical Centers (ASCs).

Health plans that proactively adopt and implement SDOH screening tools across various care settings, including annual wellness visits and in-home healthcare visits, can gain significant advantages. By utilizing providers of in-home Comprehensive Health Assessments, such as Matrix Medical Network, health plans can:

• Offer more personalized and effective care interventions 
• Gather valuable data to develop targeted interventions and community-based support programs
• Enhance care coordination and deliver more personalized, patient-centered care
• Contribute to efforts aimed at reducing health inequities and improving population health

Types of SDOH Screening Tools

As health plans begin incorporating these new requirements into their standard workflow, there will be many considerations to address. The first and most important question is what screening tool to use.

CMS requires providers utilize an approved SDoH screening tool but does not require a specific one. Rather, they require that the one used covers all 5 SDoH domains. For a comprehensive list of all screening tools, check them out here. 

We’ve provided a summary of 2 common screening tools available and in-use today. 

PRAPARE (The Protocol for Responding to & Assessing Patients’ Assets, Risks & Experiences)

PRAPARE, which consists of 12 questions and basic demographic information, is one of the most widely used screening tools because of its wide-ranging applicability across various healthcare settings. This screening can be administered by staff/health care providers or on a computer, providing for more flexibility among diverse patient populations and settings. 

When provided via a computer, it can record findings directly in a patient’s electronic health record. For example, healthcare providers can now use select ICD-10-CM codes to identify patients with potential health hazards that may be related to socioeconomic and psychosocial circumstances. Finally, this screening tool is offered in 25 different languages, making it one of the most accessible options available. 

The Accountable Health Communities (AHC) Health-Related Social Needs (HRSN) Screening Tool

This tool is the Medicare-developed & approved screening tool. It too applies in a wide variety of settings and exists in three different versions: a standard version for self-administration, a proxy version for parents or caregivers to answer on behalf of patients, and a multiuse version that accommodates both self and proxy responses with gender-inclusive language. It can be administered in three ways: self-administered by patients, proxy-administered by guardians, or screener-administered by healthcare providers. 

Logistically, screenings should occur at least once every 12 months and can take place in various healthcare settings, including clinics and during telehealth visits. The timing of screenings can be flexible, occurring before, during, or after clinical appointments to best meet patient needs.

Wrapping Up

Various screening tools exist – health care providers have the flexibility to choose the most appropriate tool for their patients’ needs, as long as it covers the required SDOH domains.

As the healthcare industry continues to evolve towards a more holistic approach to patient care, SDOH screening tools will play an increasingly important role in improving health outcomes, reducing healthcare costs, and promoting health equity. Health plans that proactively adopt programs that include screenings for SDOH will be better positioned to provide personalized, effective care interventions and gain comprehensive insights to inform future plan design and delivery.