HomeHealthPutting SDOH Data to Work for Systems and Patients

Putting SDOH Data to Work for Systems and Patients


Effective patient engagement is driven by two things: relevance and consistency. Both of these features stand on the shoulders of robust, comprehensible data.

First is consistency. When deploying engagement strategies, enterprise-level alignment is key; it reaps rewards for all involved — patients and care teams. There is a new opportunity to move away from haphazard outreach and toward a process that is scalable, replicable, and reliable at any point in the patient’s journey.

But consistent experiences need not be generic experiences. It’s important to go beyond health journeys that make the patient feel like a passive participant. Instead, move toward thoughtfully orchestrated experiences that guide patients seamlessly through their care, especially when they need to conquer barriers to access treatment.

One of the great benefits of a comprehensive, personalized patient engagement approach is the ability to ensure that each patient’s care needs are scheduled intelligently. In an ideal scenario, where we can easily review and understand every aspect of the patient’s health and social needs, we can create journeys tailored to their unique requirements. Returning to the theoretical single mother example in our earlier article — perhaps she’s lucky to have one afternoon free in a three-month period. If that’s the case, the health enterprise better make the most of the time they have with her, perhaps by building appointments — scheduling a well-woman exam and a mammogram on the same day, for instance. This creates a more convenient, seamless experience for her and enables the enterprise to close multiple care gaps at once.

Similarly, having patient data on hand allows care to be prioritized in a way that makes sense and lessens the danger that patient needs will go unanswered. If the patient needs an annual wellness visit, a colonoscopy, and a referral to endocrinology, for example, effective patient engagement would prioritize the referral, ensuring that the care sequence is logical and that the patient can access the support they need as quickly as possible.

Patient engagement touches everyone

Taking a more comprehensive approach to patient engagement doesn’t solely benefit the patients themselves. It’s also a boon for healthcare systems and teams. Too often, healthcare teams are underwater, fighting to deliver quality care while barely able to care for themselves. Patient needs and the needs of healthcare workers sit in parallel. In both cases, we can leverage data and tactical opportunities to lighten the load.

Data-driven engagement is the best way to assist patients through moments of need. Only when we understand patient needs can we begin to address their SDOH barriers and track long-term quality-of-life improvements. That being said, targeting certain high-need groups will only get you so far. Actually preventing individual patients from falling through the cracks involves a higher level of data analysis, data-driven action, and personalization.

Data collection and patient engagement should go hand-in-hand. The better we understand our patient populations, the better we will be able to bolster value-based care initiatives and help populations achieve their highest level of health.

From operational realities to equitable futures

Bringing true equity to healthcare in a society and world so marred with inequities can feel like an overwhelming or even impossible task. But each of us has a domain that influences patient outcomes, and those of us involved in healthcare operations have significant power to change the patient experience.

There are nearly endless ways to start bringing about true health equity in our immediate communities. We’ve seen how enterprise-level engagement strategy can optimize resource utilization across all care sites, releasing team members to operate at the top of their licenses and ensuring that patients get at least some form of immediate support for their most pressing needs. We’ve also seen that data-driven technology platforms do a better job of intelligently catering to patient preferences, increasing the chance that patients will feel comfortable and empowered to access care. We’ve even seen how an action as simple as transparently communicating the purpose of data collection can help patients contextualize these initiatives and answer surveys honestly and without fear.

As we continue to collect patient data, we are well-positioned to leverage our insights and direct patients to resources appropriately and conveniently, based on their unique SDOH needs. A benefit of this approach is that we don’t have to wonder if it’s hitting home — our patients can tell us. We’ve seen patients proactively thank healthcare systems for taking the opportunity to redirect them to related resources. It is possible to respond to SDOH needs with scalable resources, even if we can’t enact wide-scale change right away.

For healthcare leaders, actionable SDOH insights are key to advancing equity and improving patient outcomes. By investing in comprehensive engagement strategies and leveraging technology, the healthcare industry can build trust, address barriers to care, and ensure that no patient falls through the cracks. With a deeper analysis of patient data, cross-enterprise collaboration, and journeys tailored to specific needs, we can enable sustainable, equitable solutions for diverse patient populations.

Photo: ipopba, Getty Images

Carrie Kozlowski, OT, MBA, is Co-founder and COO of Upfront by Health Catalyst, a fast-growing, impactful digital health company. Upfront partners with provider organizations to digitally engage with patients, transforming their experience and guiding them toward completing necessary care steps through personalized, curated content grounded in health communication science. Carrie has spent the last twenty-plus years combining real-world clinical experience with strategic thinking and business acumen, leading strategy, operations, and talent development for forward-thinking companies united by the common goals of elevating population health and patient engagement outcomes. Carrie’s clinical background includes experience providing direct care, training, and management services as a practicing occupational therapist in Houston and Chicago. She holds a master’s degree in business administration from the University of Illinois, Chicago, with a focus on entrepreneurship and strategic change management, and a bachelor’s degree in occupational therapy from the University of Hartford.

This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.



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