Addressing social determinants of health in revenue cycle management

As factors like housing and education influence patient outcomes and costs, the importance of social determinants of health (SDoH) has increased. Integrating SDoH into revenue cycle management (RCM) processes supports equitable care, reduces uncompensated care and boosts patient engagement.

Understanding SDoH

SDoH are non-medical factors that affect health outcomes. They include economics, education, access to quality healthcare, neighborhood conditions, social connections and discrimination. The link between SDoH and patient outcomes is significant, with poverty and unsafe living conditions leading to higher rates of chronic illnesses. Limited education and quality healthcare access hinder proper treatment and increase reliance on emergency services. Addressing SDoH allows providers to create personalized care plans that improve patient outcomes. Incorporating SDoH into RCM lowers readmission rates and costs linked to untreated conditions. Focusing on preventive care using SDoH data enhances economic performance.

The role of SDoH in RCM

Uniting SDoH with RCM embraces patient-centered care by addressing factors that influence patients’ ability to pay. How does it affect operations and reduce avoidable costs?

Expanding beyond traditional RCM

Traditional RCM focuses on claims processing and payment collection. By integrating SDoH, providers proactively identify challenges that might prevent care. This reduces unpaid claims, minimizes unnecessary emergency visits and ultimately lowers healthcare costs.

Key areas of impact

Many individuals affected by SDoH qualify for Medicaid or state-funded insurance but face enrollment challenges. Providers can enhance enrollment by using SDoH to identify those needing assistance and offer flexible payment plans and patient navigation solutions. Collaborating with community partners for outreach helps identify financial barriers early.

Strategies to address SDoH in RCM

Integrating SDoH into RCM requires a comprehensive approach. The following strategies highlight tangible actions to ensure SDoH are addressed in RCM systems.

• Data collection and integration. Patient surveys collect income, housing stability, food security, education and employment information. Community partnerships and collaboration with community health workers also identify challenges impacting patient health and payment ability. Utilizing SDoH data in electronic health record (EHR) systems provides a comprehensive view of the factors affecting patients, guides treatment decisions and helps financial counselors address potential payment issues before they affect patients.
• Leveraging AI and machine learning. AI and machine learning analyze patient data to identify at-risk populations based on socioeconomic factors, highlighting those needing additional support. This enables healthcare organizations to intervene early. Additionally, AI forecasts healthcare utilization, helping providers allocate resources effectively.
• Patient engagement. Informing individuals about financial assistance programs through outreach and counseling, enabling them to access necessary care without incurring significant debt, builds trust. Reducing any stigma by training staff to inquire empathetically creates a supportive environment that makes patients feel comfortable discussing their needs with providers.
• Collaboration. Partnering with the community to address unmet needs and collaborating with groups focused on SDoH enables providers to support patients in areas beyond clinical care. Involving social workers and case managers improves holistic care delivery. To effectively tackle SDoH, providers must encourage insurers to cover SDoH-related services to reinforce its significance.
• Technology solutions. Predictive analytics can help healthcare organizations forecast financial risks related to SDoH by analyzing patients’ socioeconomic trends. Anticipating non-payment issues allows providers to offer proactive financial counseling, ensuring patients stay current on bills and seek necessary care.
• Integration of SDoH into RCM platforms for seamless processing. Boosting RCM with SDoH data consolidated in their systems allows financial teams to evaluate clinical and social factors when determining a patient’s financial responsibility. It creates a comprehensive approach to billing and collections, ensuring that financial support resources accompany clinical care. RCM systems equipped with SDoH features automatically alert financial counselors when a patient may need assistance, improving access to services.

Challenges and considerations in addressing SDoH in RCM

While integrating SDoH into RCM offers numerous benefits, healthcare organizations must also navigate hurdles to ensure that SDoH strategy implementation is effective and compliant.

• Data privacy and compliance. HIPAA compliance for SDoH data involves several challenges. A key concern includes securing patient consent that meets HIPAA standards and strict protocols for data confidentiality, including encryption and role-based access. SDoH data should be de-identified or segmented to mitigate privacy risks and sharing with third-party partners must comply with privacy laws.
• Regulatory compliance. As healthcare regulations around data privacy and security evolve, healthcare providers must stay informed about changes in compliance requirements related to SDoH data. This includes federal and state laws and payer-specific rules that affect the use and sharing of SDoH information. Healthcare organizations need to be sure to update their policies.
• Operational and financial barriers. SDoH initiatives involve costs that must be addressed. Training for new processes can be expensive. Adapting workflows often requires investments in new technologies and changes in billing and patient intake. Additionally, the collection and analysis of SDoH data necessitate advanced technology solutions, such as EHR software upgrades.
• Sustainability of funding. Healthcare organizations face funding challenges when addressing SDoH and ensuring the sustainability of their initiatives. While government programs, grants and payer incentives offer some financial support, many organizations depend on private funding or their operational budgets. This dependence hampers the ability to scale up or maintain SDoH initiatives. Although addressing SDoH improves patient outcomes and reduces long-term costs, healthcare organizations often struggle to quantify short-term ROI, requiring them to weigh initial investments against potential savings and improved patient care.
• Resource allocation and prioritization. Addressing SDoH means competing for resources, making it challenging to secure funding and staffing. Organizations must strategically prioritize SDoH initiatives to align with broader goals. SDoH added into RCM processes increases staff workloads. Poor management of this may lead to burnout, decreased job satisfaction and higher turnover, complicating the integration.

Conclusion

Integrating SDoH into RCM provides equitable care and improves financial outcomes. By addressing economic and social barriers early in the RCM process, providers enhance patient experiences and reduce costs. This approach aligns with value-based care models and improves overall health outcomes. The long-term benefits are significant despite the challenges. Prioritizing SDoH initiatives and partnering with specialized RCM companies to streamline management and ensure compliance is a proactive step that fosters more equitable and efficient healthcare.