SAN DIEGO — Health care providers on the front lines are in a position to see the effects of social determinants on wellness and care. Now is the time for leadership to take on these issues in a concrete way.

That was a key message from Rishi Manchanda, M.D., president of HealthBegins, an organization that focuses on health equity, during his keynote address Thursday at the American Hospital Association’s Leadership Summit.

“Addressing social factors has been a part of the public health sphere for a while, but due to a convergence of multiple factors, now is the time to get things done,” said Manchanda, who is also the founder of Rx Democracy, a coalition dedicated to registering voters in health care clinics.

Manchanda says there have always been providers dedicated to thinking beyond biology and behavior when assessing patients — a group of providers he describes as “upstreamists.” But as part of the move to value-based care, he notes increased interest from payers around social issues, which has strengthened the case for providers to create strategies to address upstream factors.

Manchanda pointed to such efforts as the Centers for Medicare & Medicaid Services' Accountable Healthcare Communities and Medicaid managed care organizations as as examples driving that momentum.

In remarks similar to those he made to H&HN earlier this year, Manchanda expressed his belief that tackling social health needs such as food insecurity can lead to better outcomes, improve the patient experience, strengthen the provider experience and reduce costs.

He enumerated four ways health systems can look upstream to improve care:

  1. Rethink: “The first thing before we embark on any new way of doing something, before we change our behaviors organizationally and individually, is to have a new story. What are we going to do if we don’t have a new way of thinking — we’re going to do it the old way.”
  2. Redesign: This boils down to the "get ready, get set, go" approach. “Social determinants is not about tackling macro-level poverty change yet. Fundamentally, for our teams in our hospitals it’s about getting ready.” That involves an assessment of an organization's readiness to begin addressing social needs. “Then we get set. Identifying an upstream cause, such as food insecurity. You pick one that is of strategic importance and identify who our upstreamist is and who is our upstream partner. We can then get going to provide a quality improvement structure."
  3. Deploy: “This just means doing what we’ve been doing” This involves using tools already in place to create quality improvement.
  4. Rebalance: “We can’t actually address equity without addressing the inequity in society," he said. He suggested that providers invest resources "upstream for secondary prevention — maybe invest in the community. Maybe do things to talk to CMS about making sure we get support for this in hospitals. The solutions are out there.”

Whether a system is just getting started or has been addressing social needs for years, Manchanda stresses that this must be an integral part of a system's overall approach.

“I don’t recommend doing this anecdotally,” Manchanda said. “Invest and use rigor. This is about improving patient care — if it takes getting a patient a refrigerator to make them better, that’s improving patient care.”