Trenor Williams, MD, is a family physician, entrepreneur, former health system executive and consulting leader. He’s also co-founder and CEO of Socially Determined, the social risk analytics company for organizations committed to addressing the Social Determinants of Health (SDOH).
In this interview, Trenor shares insights on SDOH and why they should not just be a focus of the healthcare community. He explains why employers should begin paying more attention to these factors, the impact they can have on the top and bottom lines, and the steps business leaders can take towards effective SDOH initiatives.
Trenor Williams
Q: Why should employers care about the social determinants of health (SDOH)?
TW: Beyond the fact that taking care of your employees is just the right thing to do, paying more attention to the social determinants of health can help improve the health of a business too, especially in two key areas: cost and productivity.
On the cost side of the equation, employers are the ones largely funding healthcare in the United States. Business leaders are very aware of the unsustainable growth of healthcare spending that’s approaching 20% of GDP. And they’re footing a big part of the bill because of the way healthcare is structured around employer-sponsored plans in the U.S. Business leaders have been seeing premiums rise around 5% year-over-year for decades, and there’s still no end in sight.
So, what does this have to do with SDOH? We know that 80% of health outcomes are attributed to the social factors in a person’s life, such as their access to healthy food, stable housing and reliable transportation, their economic wellbeing, and their level of health literacy. That means only 20% of outcomes are influenced by the care a person receives from a healthcare provider.
It’s simple math. Focusing on SDOH needs to be a key component to flattening the curve of rising healthcare costs in this country. People and organizations in the healthcare industry have started to pay more attention to SDOH to ensure it’s part of the solution, and it’s time for employers to join them. When you consider how much of the healthcare industry is funded by employers, they have too much at stake not to.
This brings me to the other major reason employers should focus on improving the social determinants of health among their workforce: employee metrics such as absenteeism, presenteeism and productivity. Every employee is trying to manage their lives the best they can and if someone is fragile from a housing or economic standpoint, it will detract from them being fully present at work. The time they spend thinking about the obstacles and barriers in their life can understandably have an impact on their ability to do their job – and I think most of us have witnessed this firsthand living through the pandemic over the past year.
On top of presenteeism, there’s also the issue of absenteeism, which SDOH can impact too. For example, if someone lacks transportation – maybe multiple family members are sharing one car in a town where public transportation is not reliable – they’re probably more likely to miss work.
The bottom line is pretty clear – an employee’s health and work are impacted by the life challenges they face every day. It’s in everyone’s best interest to support employees as they address and overcome these challenges, especially as it becomes more and more apparent how significant the social determinants of health are in keeping people happy and healthy.
Q: A person’s healthcare and personal life are very private and they are not typically areas where an employer can or should become involved. When it comes to addressing the social determinants of health among a workforce, how can an employer navigate this?
TW: Historically, employers haven’t been sure what type of information or data they should use or have access to, and just as importantly, what they would be able to do with the data once the access it. Both are real challenges, but they can, and should be addressed.
First, there’s so much we can learn about the risk exposure of a company’s employees without using identifiable data. This is important, because to really make a positive impact, SDOH initiatives don’t have to be focused solely on individual people or employees. In fact, they shouldn’t if you really want to create change at scale.
Creating wholesale change requires action at both a community and individual level, which can start just by knowing where a company’s facilities or offices are located. Then you can look across neighborhoods, cities and communities to understand risk at a very granular level, see the contours of where certain risks increase or decrease, and put programs in place to address them.
Think about this in the context of supply and demand. If demand is the social risk facing employees and their families, supply is the resources available. Those resources could be things like financial counseling, access to healthy food or better transportation options. Once you understand the factors influencing supply and demand, you can begin to address them. This could mean reevaluating benefits packages or fine-tuning your health plan the next time annual renewals come around. It could also mean working with government and community stakeholders to help improve infrastructure or social programs in a region. There are a lot of options to think differently about these issues once you understand them.
You can even take all of this a step further by looking at where employees live, their salaries, job types and other factors, and analyzing the links between these things and social risk factors. This can all be done in a de-identified way that looks at subsets of your employee base and not individuals – which again, is how you’ll make the biggest impact.
Having said all that, it’s technically challenging to compile social risk data from various sources so you can juxtapose it with information on your employee base. And there’s also a high degree of responsibility in compiling employee data and then ensuring that it’s properly accessed and anonymized. These are two big reasons why organizations turn to Socially Determined as their analytics partner for SDOH initiatives. Our platform is HITRUST certified to work with personally identifiable data and health information in a thoughtful, secure and disciplined manner. Then we can help aggregate it and present it back to an employer in a form they can use. Plus, we’ve already done the heavy lifting acquiring data on communities, residents, infrastructure and businesses from open and commercial sources and organizing it in a way that can reveal the social risk contours of a community – and the people in it – at a very granular level.
Q: What are the first steps employers can take to start addressing SDOH among their team?
TW: The first thing you want to do is create a baseline of knowledge around the social risk for your communities and employees. As I talked about earlier, the easiest place to start is understanding where your facilities are, where your employees live and the social risk they are exposed to. For some organizations, this could be within a single community, but for many large businesses it could mean hundreds of sites across the country or world. Without this knowledge, there’s no way to begin to understand the relationship between your organization and social risk in the community. However, by understanding what percent of your employees live in areas of elevated risk for things like housing, food, economics or transportation, you can begin to think strategically about these issues as opposed to always being reactive. And to gain even deeper knowledge of social risk, employers can focus of the specific risks and challenges facing each employee. For example, even though a person lives in a community with low risk for food insecurity, they could still have elevated personal risk because of their specific situation. As companies think about addressing these challenges, it’s crucial to understand these intricacies. Utilizing data and risk insights in the right ways will be understandably more specific and will help employers build upon their knowledge of community risk.
Another natural step, which I’ve started to see among some national employers, is to work with national partners like Aon or Willis Towers Watson, who are trusted advisors working hand-in-hand to develop benefits strategies. After you bring these organizations into the conversation to support the work you’re doing together, you can start evaluating benefits, rewards strategies, place-based interventions or other strategies. Any of these things can be great starting points to take action, but only after you know what risk looks like. As employers increase their visibility of both community and individual risks, they will be able to positively impact their employees, their communities and their business by using a data-driven approach to create specific intervention strategies.