By John Farah, PhD, Veradigm
Socioeconomic and place-based factors—collectively known as social determinants of health (SDOH)—are affecting how communities and individuals are coping with the unprecedented COVID-19 crisis. COVID-19 has left Americans who are living with social determinant risk more vulnerable than ever before.
Social determinants of health include the influences and systems that affect daily life; they impact overall health, well-being, and longevity to a greater extent than medical care itself and are the main drivers of health disparities and inequities.
Occupational and employment status, income level, food insecurity, education, transportation availability, racial segregation, housing access, and social support and community inclusivity are social determinants that figure prominently in the COVID-19 pandemic.
The COVID-19 pandemic has amplified social determinant risk
As people lose their jobs and health insurance because of the growing economic fallout, they join the ranks of Americans with increasing social determinant risk. Statistics signal increasing stress on the safety net and the economy:
- Across a 14-week period, about 47 million Americans filed jobless claims amid lockdowns and mandated closings of nonessential businesses.
- Nearly one-third of Americans did not pay rent during the first week of April.
For many Americans, food insecurity has materialized or has been exacerbated by loss of income; efforts to control the spread of virus, including sheltering-in-place and social distancing directives; reduced options for public transit; and empty food shelves caused by overbuying and hoarding:
- A recent, drive-through food bank distribution drew a line of cars with over 1,000 families.
- Meals on Wheels programs, which deliver food to the housebound and elderly, are dealing with a sudden influx of older Americans, with fewer volunteers available to help with meal deliveries.
School closings due to COVID-19 have placed a strain on parental employment, and there is concern that some students may fall behind without formal instruction. In addition, families that depend on subsidized or free breakfast and lunch are experiencing greater food insecurity:
- Across the country, many schools have extended closures through the end of the 2019-2020 academic year.
- Increasing numbers of food service workers who test positive for coronavirus have caused school districts to stop or scale back food distribution efforts.
Social determinants of health are intensifying risks from COVID-19
Social determinant risk is common in nursing homes, as residents are often poor and rely on Medicaid. Being elderly with chronic conditions leaves seniors highly susceptible to the ravages of COVID-19:
- Across the US, more than 12,000 long-term care facilities, including nursing homes, have reported cases of coronavirus. More than 267,000 residents and staff members have contracted the virus, with over 51,000 deaths reported.
Inequities related to crowded housing, segregation of poor communities in urban environments, essential workplace jobs, high rates of chronic disease, and an inability to afford or secure critical medicines contribute to COVID-19-related morbidity and mortality:
- US counties whose populations are predominantly black have COVID-19 infection rates that are three times that of counties whose populations are predominantly white. Rates of fatalities are nearly six times higher for the former than for the latter.
What is being done to mitigate the effects of COVID-19 at local, state, and federal levels?
With mitigation efforts underway, various initiatives specific to COVID-19 and social determinant risk are being implemented. To name a few:
- Local food banks and their network of relief organizations have stepped up to feed increasing numbers of hungry Americans. Feeding America, a US–based nonprofit with a network of over 200 food bank members, has launched the COVID-19 Response Fund, a national effort focusing on food-procurement and fund-raising.
- Regional grants are being administered to address job loss or insecurity, homelessness, and food insecurity.
- A plan to cover expenses associated with COVID-19 for 213 nursing homes has been announced by Connecticut state officials. Nursing homes will receive $35 million to cover operational costs and increased Medicaid payments to help meet extraordinary costs.
- The Families First Coronavirus Response Act "provides paid leave, establishes free coronavirus testing, supports strong unemployment benefits, and expands food assistance for vulnerable children and families."
- A $484 billion federal aid package has been approved for small business loans and hospital funding.
While multiple initiatives have targeted COVID-19, expanded and sustained effort will be required to limit its impact over the coming months.
How has Veradigm™ mobilized to combat Covid-19?
As a leading provider of data and technology solutions, Veradigm is supporting providers and their patients, including those affected by socioeconomic and place-based risk.
Importantly, Veradigm is continuing its longstanding policy to offer services related to its EHR platforms, without charge, to the free clinics serving on the front lines of the pandemic.
During the peak period of this crisis, Veradigm is offering free videoconferencing to its healthcare providers to enable delivery of services through telemedicine.
In addition, Veradigm is a founding member of a consortium of leading healthcare companies who announced the launch of the COVID-19 Research Database, a secure repository of HIPAA-compliant, de-identified, limited pandemic-related patient data. The repository, which includes real-world data from electronic health records and medical and pharmacy claims, has been made available, pro-bono, to public health and policy researchers for generating insights into the COVID-19 pandemic.
Other Veradigm initiatives with relevance to COVID-19 and social determinant risk include
- Incorporating the newly released clinical classification code for COVID-19, implementing COVID-19 questionnaires, and providing support regarding the latest government updates within the clinical workflow
- Launching a physician and patient resource section within our website that includes information on preparedness, screening and testing, prevention and control, management and treatment, and patient education
- Using information technology tools such as natural language processing to extract and standardize social determinant data within EHRs (AMIA Symposium)
- Generating real-world evidence actionable and meaningful to a discussion of social determinants in chronic disease.
During these extraordinary times, Veradigm is acting rapidly and doing its part to enhance healthcare delivery and ensure access to datasets and analytics to understand and help mitigate the ongoing COVID-19 crisis.
Veradigm is an integrated data systems and services company that combines data-driven clinical insights with actionable tools to help healthcare stakeholders improve the quality, efficiency, and value of healthcare delivery— including biopharma, health plans, healthcare providers, health technology partners, and most importantly, the patients they serve. We are dedicated to simplifying the complicated healthcare system with next-generation healthcare solutions. This is how we are transforming health, insightfully. To learn more, visit www.veradigm.com.
AMIA Symposium. Extracting and standardizing social determinants of health diagnosis from problems list from a large ambulatory electronic health record (EHR) database. 19 Nov 2019.