Social Drivers of Health (SDOH)

Dear Reader,

Thank you for your incredible engagement and thoughtful interactions with my recent article. Several of you reached out specifically about Social Drivers of Health (SDOH) topics, and I’m truly inspired by the passion and curiosity you’ve shared.

Given the interest, I wanted to take the opportunity to dig a little deeper into SDOH requirements. For those looking for more insights, I hope this follow-up article provides clarity and sparks new ideas for advancing health equity in your organizations.

Your questions and feedback fuel these conversations, and I’m always open to hearing more from you. Let’s continue to connect, learn, and grow together!

Preparing for 2025: Addressing New SDOH Requirements

As 2025 begins, hospitals across the country are adapting to new Social Drivers of Health (SDOH) reporting requirements mandated by the Centers for Medicare & Medicaid Services (CMS). Starting January 1, 2024, hospitals must screen all inpatients for five key social risk factors: food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety. Data collected in 2024 must be submitted to CMS by May 15, 2025.

2025 Requirements

Mandatory SDOH Screening and Reporting:

• Requirement: Beginning January 1, 2025, hospitals must screen all inpatients for five key social risk factors. Data collected throughout 2025 must be submitted by May 15, 2026.
• Leader Action Item: Convene your care management, social work, nursing and analytics teams to ensure a streamlined screening process is in place and verify that your organization has the infrastructure to collect and securely store data. Begin preparations for timely submission.

New SDOH Reporting Requirements Expected to Impact HI Workflow, Staffing

Hospital Commitment to Health Equity Measure:

• Requirement: CMS is finalizing the adoption of the "Hospital Commitment to Health Equity" measure, beginning with the CY 2025 reporting period, which will affect payment determinations in CY 2027.
• Leader Action Item: Review your organization’s existing health equity initiatives and create a cross-departmental task force to address gaps. Ensure leadership is aligned on measurable goals to achieve compliance with this measure.

CY 2025 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Proposed Rule

2026 Requirements

Screening for Social Drivers of Health Measure:

• Requirement: CMS is implementing the "Screening for Social Drivers of Health" measure, with voluntary reporting in CY 2025 and mandatory reporting in CY 2026. This measure assesses the percentage of patients screened for SDOH.
• Leader Action Item: Develop training programs for clinical and non-clinical staff on SDOH screening workflows and documentation. Track voluntary reporting metrics in 2025 to identify any process inefficiencies before mandatory reporting begins.

CY 2025 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Proposed Rule

2027 Requirements

Medicaid Disproportionate Share Hospital (DSH) Payment Reductions:

• Requirement: The Consolidated Appropriations Act, 2024, delays Medicaid DSH payment reductions until FY 2025, with reductions scheduled to begin January 1, 2025, and continue through FY 2027. Hospitals serving Medicaid and uninsured patients should prepare for these funding changes.
• Leader Action Item: Conduct a financial risk assessment to evaluate how Medicaid DSH payment reductions will impact your hospital. Consider expanding community partnerships to help alleviate financial strain on vulnerable populations.

Medicaid Disproportionate Share Hospital (DSH) Reductions

Looking Ahead: Pending Legislation

The Social Determinants Accelerator Act (H.R. 2503/S. 3039) offers funding to states, local governments, and tribal entities to develop innovative strategies for addressing SDOH. By providing planning grants and technical assistance, this bipartisan bill helps improve health outcomes for Medicaid participants.

Social Determinants Accelerator Act

Final Thoughts

Your continued investment in Care Management and Social Work teams will not only help meet these requirements but also elevate patient care and foster stronger connections with the communities you serve.

Key Interventions by Case Managers and Social Workers:

1. Food Insecurity: Partner with local food banks or community programs to provide immediate resources for patients, reducing malnutrition-related readmissions.
2. Housing Instability: Collaborate with housing assistance organizations to secure stable housing, fostering better recovery and long-term outcomes.
3. Transportation Needs: Develop ride-share programs or hospital-sponsored transportation services to ensure patients can attend follow-up care.
4. Utility Difficulties: Connect patients to utility assistance programs to address essential needs like heating and electricity, improving recovery environments.
5. Interpersonal Safety: Conduct risk assessments and collaborate with local shelters or crisis teams to address domestic violence and unsafe home situations.

As always, I welcome your thoughts, questions, and knowledge-sharing as we navigate these changes together.

 #HealthcareLeadership #SDOH #CareManagement #SocialWork #HealthEquity #HospitalManagement