Advancing Health Equity: Lifepoint Health's Strategic Implementation of SDOH Measures

Over the past few years, there has been an emphasis placed on health equity – identifying where and how it doesn’t exist, how to identify it, and tracking the numbers attached to the people.

Recently, Medisolv had the pleasure of presenting about capturing this equity data successfully with Lifepoint Health System at the HIMSS Conference. Here we discuss the regulatory requirements and highlight the good work that our friends at Lifepoint are doing.

Health Equity in Quality Measurement & Management

This year, CMS continues to put a lot of emphasis on health equity. They identify three main strategies for equitable care: identifying at-risk populations through direct patient screening, stratifying collected data by health equity variables like race, gender, and financial class to improve care for underperforming groups, and using health equity variables in risk adjustment of quality measures, including tools like the Area Deprivation Index (ADI) to enhance service and payment for underserved populations.

Health Equity Measures

There are three required health equity measures in the Inpatient Quality Reporting (IQR) program in 2024:

1. Hospital Commitment to Health Equity measure (HCHE)
2. SDOH-01: Screening for Social Drivers of Health
3. SDOH-02: Sceen Positive Rate for Social Drivers of Health

All three measures are required in 2024 and will be publicly reported on Care Compare.

The measurement window for all three follows the calendar year (January 1, 2024 – December 31, 2024) and the submission window runs April 1 to May 15, 2025.

HCHE – Hospital Commitment to Health Equity

CMS emphasizes HCHE as an assessment of hospital leadership’s commitment and an important step toward closing the gap in providing equitable care for all populations.

HCHE uses organizational competencies to achieve equity for the various groups of concern:

• Racial and ethnic minority groups
• People with disabilities
• Members of the LGBTQ+ community
• Individuals with limited English language proficiency
• Rural populations
• Religious minorities
• People facing socioeconomic challenges

HCHE measure assesses across five domains. One point will be issued for each of the five domains. You must attest to each statement within each domain to get a point. The statements are listed in the box on the right. And you must attain all five points to meet the requirement for the measure.

Social Drivers of Health (SDOH)

Social drivers of health are conditions in the environments where people are born, live, work, play, worship, and age that affect a wide range of health, functioning and quality-of-life outcomes and risks.

SDOH can be grouped into five categories:

1. Education access and quality
2. Health care access and quality
3. Neighborhood and built environment
4. Social and community context
5. Economic stability

The SDOH-01 and SDOH-02 measures require hospitals to screen all inpatients for health-related social needs (HRSNs). HRSNs are social conditions that can negatively impact a person’s health or health care and thus be at the greatest risk of poor health outcomes. (Measure information on the right.)

Understanding a patient’s HRSNs has significant benefits, including enabling systematic collection of data and supports commitment to address those disparities. Once you have the data, you can dig deeper into understanding where gaps exist so that disparities can be addressed. It also encourages working with community partners and leveraging existing resources in your community.

Like the SDOH, HRSNs can also be grouped into five categories:

1. Food insecurity
2. Housing instability
3. Transportation needs
4. Utility difficulties
5. Interpersonal safety

One of the rationales for the SDOH measures is that 92% of hospitals screen for one or more of the five HRSNs – which is terrific. But only 24% screen for all five HRSN categories. This is a massive gap.

Screening for Social Drivers of Health

The end goal of the SDOH measures is to identify high-risk patients with improved accuracy, address disproportionate expenditures, reduce barriers to accessing healthcare, and ultimately improve the quality of care that our patients are receiving.

Hospitals must submit two Process measures. You will attest to this data via the hospital quality reporting (HQR) system, and when you do so, you will be submitting two populations (a numerator and a denominator).

SDOH Measure Implementation Across a Multi-Hospital Organization: Lifepoint Health

Lifepoint Health is a healthcare system that employs more than 50,000 people and 3,000 employed providers. They operate across 31 states; with 60 acute care facilities, 41 rehabilitation hospitals, 23 behavioral health hospitals, and more than 300 managed acute rehab units, outpatient centers, post-acute care facilities, and other sites of care.

Lifepoint has a plethora of EHR systems across their acute care environments (Meditech, Cerner, Epic, Paragon, Sunrise, and more!). So, initiating anything company-wide can be daunting.

Implementation Strategy and Timeline

Lifepoint Health started preparing in October 2022 by forming a health equity steering committee. They began by evaluating the requirements, looking at screening tools, identifying vendor solutions and determining methodology. Two of their executive vice-presidents both stepped up and emphasized to the company at large the importance of these initiatives.

The steering committee was comprised not only of these two executive leaders but also other senior staff such as chief medical and nursing officers, and senior leaders from various departments such as Operations, Compliance, Information Technology, Clinical Quality/Risk, etc.

Next, Lifepoint worked to identify key resources to help them complete project tasks. For example, their Quality and Health IT departments focused on implementing and rolling out requirements into the EHR systems. Marketing and Outreach Services compiled lists of community resources already in place. Next up was to develop a project plan and organize workgroups who could complete tasks by a deadline.

Initial Evaluation

From the beginning, Lifepoint was examining how SDOH data would be captured in their EHRs. Some of the data was recorded, but it was scattered and inconsistent, which would not work to fulfill the requirements. They had to determine if it was time to roll out a standard screening tool across all facilities or allow the flexibility that already existed to continue.

Additionally, Lifepoint had to consider how the data would be compiled for reporting and tracked across the company. They considered a list of vendors and decided to use Medisolv.

Lifepoint's Collaboration with Medisolv for Digital Solution

Medisolv and Lifepoint have worked together for a decade and 60% of their facilities used Medisolv for eCQM tracking and reporting. The concept of implementing SDOH measures as eCQMs was attractive, given the emphasis toward moving to Digital Quality Measures. And Medisolv could provide a centralized dashboard as an easy mechanism to review performance across the various facilities in the Lifepoint Health System.

Early on, Lifepoint utilized the SIREN Social Needs Screening Tool Comparison table to aid in their process but then landed on the CMS accountable health communities (AHC) HRSN tool, which felt simpler once they realized that the first 9 (of 26 total) questions were the core responses needed. The goal was to keep the initial screening of HRSNs as brief as possible while still addressing all five needed domains.

Another benefit of using the CMS AHC HRSN tool is that although most of our facilities can get by with responding to the 9 core questions, sites are able to add additional questions if desired. State reporting in Kentucky required 14 questions, and they were easy to incorporate for facilities located there.

Screening Questions

As Lifepoint began rolling out the screening questions, they carefully considered when and how the questions would be asked. Should they be addressed during patient registration? During the nursing admission assessment? During case management's assessment?

There were concerns about having registration staff ask the questions due to the high level of sensitive information that they needed to inquire about, on top of adding to their already busy workloads. Nurses are more comfortable asking sensitive questions but have concerns about probing into patients’ financial situations. Case Management staff are also more comfortable with asking sensitive questions, but typically are not staffed seven days a week.

As a result, Lifepoint provided a tool for their staff that provided self-guided training around the screening questions. Staff were able to role-play and respond to situations that might arise around each of the five domains. Additionally, they provided training on how to handle positive screenings – getting case management involved and providing handouts.

Addressing Implementation Challenges

A number of challenges arose as Lifepoint went live with their screening. One that was quickly apparent was the limited availability of case managers to respond to positive responses after regular business hours and on weekends. Also, resources are not always readily available to address positive screenings, particularly in rural areas.

Another challenge was receiving responses to the screening questions in a narrative format. Patients might tell a story explaining why they were in the position that they were in, but that format is difficult to map and analyze. The standard tool also had to be expanded to capture exclusions such as “patient refused to answer.”

Overcoming these challenges involved many different departments.

• Leadership Involvement: A primary key to success was getting executive buy-in early in the process. Their leaders even started going out into the community themselves to identify resources.
• Quality & IT Alignment: The Quality and IT departments were essential in developing and implementing the screening tool in the EHR and ensuring that data was properly mapped for data capture. In addition, these groups made an effort to minimize the burden of adding documentation by automating what they could.
• Education: Lifepoint put a huge emphasis on training of staff on how to respond to positive screening results.
• Long-term strategy: Lifepoint emphasized seeking out long-term strategies for digital quality improvement by constantly tracking and monitoring the processes.

Bridging the Gap: Community Strategies

Community collaboration has proven to be one of the most vital resources throughout this process. Lifepoint’s leaders met with various agencies and community leaders where the facilities are located and identified every possible resource. They have partnered with community leaders, churches, and civic organizations to develop new resources where gaps are identified as well.

The SDOH information is vital here, too – where can they make the most impact now? What is the highest need? This has been particularly important in those rural communities where resources are lacking.

Some of the actions that Lifepoint has taken to address defined needs include:

• Changing the sites of screening clinics to better engage with at-risk populations
• Local factory workplace outreach
• Providing backpacks for patients who are currently unhoused that include hygiene supplies and weather-appropriate gear (hat, gloves, sunscreen, etc.)
• Writing grants for free blood pressure monitors to give at screening sites
• Adding in-hospital food pantry and patient clothing closets in conjunction with community partners
• Creating a medical mentorship program with local schools to address unequal representation of people of color among hospital teams

The journey of Lifepoint Health in implementing the SDOH measures underscores the critical importance of addressing health equity through systematic and strategic approaches. By forming a dedicated health equity steering committee, collaborating with Medisolv for digital solutions, and engaging deeply with community resources, Lifepoint has set a robust framework for capturing and addressing the social determinants of health.

As Lifepoint continues to refine their strategies and expand their initiatives, they serve as a compelling example of how healthcare providers can effectively bridge the gap between clinical care and social needs, ensuring better health outcomes for all populations.