Dr. Ed Clark discusses health systems investing in social determinants of health

Ed Clark, MD, of Banner Health, weighed in on whether he agreed or disagreed with a commentary titled “Health Systems and Social Services—A Bridge Too Far?” which states that health systems should not invest in social determinants of health.

This topic was further explored during the panel discussion at The American Journal of Managed Care®Institute for Value Medicine® (IVBM) in Phoenix, Arizona on December 12, 2023. Clark, who is vice president and chief medical officer of Banner Health’s plans and networks division, co-chaired the event and helped moderate the panel.


You helped moderate a panel discussion on ideas from “Health Systems and Social Services: A Bridge Too Far?” in which the authors disagreed that health systems should invest in social determinants of health. Do you agree or disagree with the points made in this comment? Why or why not?

I agree with parts of it. Especially where I sit and where my teams are at Banner Health, where we’ve made these strategic decisions as a historic delivery organization and hospital group, we’ve made a decision to take risk on population outcomes by owning insurance plans and underwriting more risk. From our perspective, it just became the job; we have to do this.

They make some excellent points in the paper because not everyone has the ability to own or co-own health plans. Similar to the points around PCPs [primary care providers] because there is so much to do, it is no different in the stationary setting. I think if you talked to almost anyone, “Do you feel like you have more work to do on any given day now than you did 10 years ago or less?”, they would all say, “I have more work to do with probably more a small amount of resources to do so.”

I think we just have to be careful to find that balance; I certainly don’t have all the answers on this one. It’s definitely not a one-size-fits-all thing. What I’m hoping for, and what many of our panelists have touched on, is that we really need intervention from our government. So our politicians have to be involved in that, and that was a question that was raised by some in our audience. In fact, several said they appreciated the panelists we had and the speakers, but a request was made for local, state and national politicians in forums like this to talk about what they are doing to help us.

Could you summarize the points made during the discussion that impressed you the most?

Some of the things that stuck with me were that getting this data is still a challenge. Screening is one thing, but how do we get the data up front from our health plan partners or other organizations? So, in addition to us checking our individual populations and taking action, can they share that data with us in advance and provide more programs so we can take action? That was one thing that stuck out.

Also, again, checking is one thing, then documenting the various Z codes and stuff. Again our new workflows and what is often perceived as more work on an already stressed group. So is there a way to rationalize this? There is still some hesitation in using Z codes and other things to document these things. Some feared that the data could be used in ways we don’t yet understand, and patients and others might not understand exactly how that data is being shared as it is collected in the EMR [electronic medical records] and in other places too.

So, there are still a lot of questions about what we can do with the data and how will that data adjust the risk of our populations, especially for those of us who take risk or have a lot of value-based contracts in our payer mix? So understanding how we get recognition for having panels with more social determinants of health versus less. Is there any relief there or how will the acknowledgment work for this? I still think we have some unanswered.

Finally, some points that were made were that until we have more capitative models or just full transfer of risk to the provider entities, we’re still likely to be in this kind of middle space where it’s really hard to get into these things fully, or we just do nothing. Especially as we all become more educated about the impact that this has and we clearly understand that, “Okay, we’ve got to tackle this and here’s how we’re going to do it,” you need those dollars potentially upfront to be able to make investments much earlier so as to create these good results. So trying to do all of this now with the hope that maybe there will be windfalls on the back end in an already stressed and overburdened primary care ecosystem is just a tall order.

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