Q&A: Pediatrician Screenings For Social Determinants Of Health

When you go to the doctor’s office, you’re probably used to getting your weight taken, your blood pressure checked, asked about medications and supplements, maybe even screened for pain.

But what if that cadre of routine checks included conversations about housing stability, food security, whether you can pay your utility bills? That’s what some say should be happening, since most of a person’s health is determined by the social circumstances she or he lives in.

There’s a movement to screen for these social determinants of health and Case Western Reserve University researcher Nisha Malhotra looked into this practice within pediatrics in a recent study published in the journal Medical Care Research and Review. She spoke with ideastream’s Anne Glausser.

Why is screening for social and environmental factors important?

What studies have begun to find is that addressing those social and environmental factors are equally, if not potentially more, important because of their ability to influence not only the medical aspect of the child's upbringing, but also other aspects of their development which become important when considering health outcomes long term.

Why do this at the doctor's office? What could a doctor do?

Because there is this idea that addressing these factors could be "medically necessary," it is important to address them in a doctor's setting. It limits the need for those children to go to multiple different locations. Also, knowing those barriers to care are important long term. And then also being able to set up for referrals to places that can potentially help them is important as well.

What are the barriers to doing this kind of screening within the doctor's office?

One is particularly time constraints of pediatricians. So already, the pediatricians have a laundry list of things that they're expected to address during their often 15-minute visit. So further research could potentially look at how addressing social determinants of health can be fit into the workflow of a pediatric well-child care visit.

Your paper in specific was looking at how to financially incentivize this kind of screening, basically using a mechanism through the Medicaid system. Can you talk a little bit about that?

Absolutely so the Early Periodic Screening Diagnosis and Treatment Benefit (EPSDT) is a policy of Medicaid that essentially provides preventive, holistic care for children at the earliest point of need. So, right from when they're born to the age of 21, no matter what a child's insurance status is or what their socioeconomic status is, they should be receiving this standard of care. And that has been a really big priority of this benefit from its conception.

Is EPSDT a way to to reimburse practices for doing this kind of screening?

There is definitely potential. In order for something to be covered by the EPSDT benefit, it needs to be considered medically necessary. And the tricky part of considering something as "medically necessary" is that there are conflicting definitions of what that means. And it actually varies on a state-by-state basis.

What about in Ohio?

Ohio Medicaid definitely emphasizes the need for addressing social determinants of health in a health care setting. They don't necessarily say that we can reimburse for screening tools at this point but they have addressed social determinants of health using EPSDT including transportation, maternal depression screening, lead screening and other services like that.

There was a new study in the Journal of American Medical Association recently, looking at hospitals nationally, not just pediatric practices, and found that less than 30 percent screened for key social determinants of health including food, housing, utilities, transportation, and violence. What's your sense of how widespread this practice is right now?

It's not a widely spread practice simply because logistically it's hard to actually reimburse for that service at this point because the precedent hasn't necessarily been set yet. Going from being strictly medical to also including those social factors is sort of this evolution that we're seeing in well-child care over time and we're finding that this might actually be a more effective way to address children's health care holistically.

As financial incentives start to align and providers can reimburse for it more and more, do you expect to see it happen more often?

Absolutely. I think it's both incentivized by the fact that you're addressing these determinants and then also if we can incorporate this Medicaid policy into it, that would really help to incentivize further.