Addressing the Challenge of Collecting SDOH Information

Hello and welcome to Healthcare IT Today, where we explore the most recent interesting trends and stories in the world of health IT. I’m Colin Hung, and today I’m excited to be talking about social determinants of health and how to collect that data because, let’s be honest, it’s pretty hard and pretty uncomfortable. 

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With me to take me on this journey is Bobbi Weber, who is the VP of Product Marketing and Customer Success at QliqSOFT. Bobbi, welcome to the program. 

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Thank you for having me, Colin. SDOH, or social determinants of health, is a tough topic, but very important, and that’s because of some new programming that’s available, the ACO REACH programs. 

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Tell me more about that program and why the collection of SDOH data is so important.

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So ACO REACH requires that you capture social determinants of health. Social determinants of health are 80% of your life decisions and actions that impact your health, so they include things like: Are you homeless? Do you have food insecurity? Do you have transportation needs? Do you feel safe in your home? These are, as you can imagine, really uncomfortable conversations to have. Even though that data has been around for a while, the capture of it has really lagged because people just aren’t comfortable having the conversation. I mean, if I look at you and say, “Do you feel safe when you’re home?”—if you didn’t, how comfortable would you be saying no, especially in a public setting?

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What we’re finding is QliqSOFT is a digital communication platform and, among our solutions, we have a chatbot. What we’re finding is that you can capture this information in the chatbot. You can send the chatbot out to the person as part of their engagement process and, in a very dignified way, you can probe into these questions. What we’re finding, as we’re working with a federally qualified health center, is that this is the ideal way to capture the information because you can do it privately, you can be comfortable being honest, and then that information simply gets fed to your healthcare professional prior to your visit. Rather than speaking to someone with a clipboard and asking these questions one-on-one, having to face and admit to somebody else that maybe you are having food insecurity, you’re doing it via a text and then you can go and engage with the chatbot to do it.

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Do you work with the FQHCs to develop these questions?

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We do. The interesting thing about our solutions is they are very robust no-code tools, and you can create your own forms. This is a great example of: I want to capture all of the data that CMS is requiring, or I want to capture only this subset of the data that I can do something about, and the organization has the flexibility to be able to do that. Working with a federally qualified health center, they said, “We want to do care coordination. We want to do food, transportation, and insurance because those are the things we can help with, so those are the things we want to capture.” Gotcha. So it’s not as if every organization is trying to capture all the questions and all the answers in one shot. Some of them can decide, “These are the areas I want to focus on, and therefore I’ll ask just those questions,” and that’s what they can program your chatbot to do. Absolutely.

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Once this information is in the system, how are the FQHCs leveraging this? Capturing it is difficult, but also how do you bring it up or have the conversation as a clinician or a care coordinator to speak with the actual patient? What the FQHCs that we’re working with are doing, I think, is pretty brilliant. They’re capturing this data in a very dignified way, and then they’re taking those answers and triggering a message to social services saying, “This patient has needs,” and then someone from social services is reaching out to address those needs. You don’t need to do that as part of the workflow of your clinical visit, but you do need to do it. What’s more interesting is when we put together these specific things they’re screening for, the highest thing that people wanted help with was actually scheduling visits. I would have expected anything else, honestly, but scheduling visits was the area that people identified as the biggest barrier to health, and so somebody reaches out and helps them.

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A third of the patients—so, of all the patients that we interviewed recently using the chatbots—58% of them identified social determinant areas where they wanted help, and you could select multiple. A third of them wanted help with care coordination and scheduling. “Bobbi, let’s get practical for a moment. You obviously work with a lot of organizations. What is a common mistake that you’re seeing these organizations make when it comes to trying to collect this very sensitive information?” A common mistake, I think, is doing it in the office as part of the workflow. It really does not fit there. It’s the wrong people asking the questions, and they can’t do anything with the answers. If you told me you had food insecurity, I’d say, “Okay,” and I’d write it down in the form if I was the front office person—and then what? So I think just thinking through the “and then what?” answer really takes you to a different solution.

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On the flip side, what have FQHCs, your customers, done well in terms of collecting this information? A couple of things. The first one is when they were putting together the conversational chatbot, you can script exactly how you want to ask the question. Given the sensitivity of the question, they really took a lot of time working with frontline staff and social workers to think through how to tee it up, how to ask it in a way that made people want to share that information. I was very impressed with how well they did with that, and I think the results they got and the honesty they got from people in those answers were important.

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Bobbi, what else is QliqSOFT working on? What are some of the more interesting problems you’re tackling on behalf of clients?

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We are laser-focused on value-based care. If you think about value-based care, if you’re signing an ACO REACH or another kind of value-based contract, you’re responsible for a population of patients, all of them, whether they show up at your door or not. What we’re seeing is 10% to 20% of patients will actually schedule a routine visit as best practice. That leaves 80% to 90% of the population unaddressed. You’re responsible for the cost of those people, so you really want to see them and see if they have issues that you need to work with. So we’re doing a lot of work with chatbot outreach and basic education: “It’s really important you come in for a Medicare wellness visit. This is what a Medicare wellness visit is. This is why it’s important for you. Let’s get you scheduled,” and then reducing those barriers to getting people scheduled.

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The other thing that’s really uncomfortable for people is data that’s called SOGI—sexual orientation and gender identity. If you think social determinant conversations are hard, imagine I look at you and say, “So, Colin, what is your gender identity?” It’s uncomfortable. We’re looking at what kinds of data—social determinants, SOGI, patient-reported outcomes—we can capture directly from the patient outside of the visit to inform care, but again do so in a way that’s respectful and actually gets people to want to engage with the health system. I think that is a critically important topic for success with value-based care, and that’s a way we can help organizations.

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“Bobbi, you’ve shared a lot of great information with us today. Where can people go to learn more about QliqSOFT?” 

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Go over to the Patient Engagement Pavilion; we’d love to talk with you. It is interesting work that’s going on right now, and we’d love to talk to you. 

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Thank you so much for sharing all that, and thank you for being on the program today. Well, thank you, Colin. I appreciate the opportunity. If you enjoyed this interview as much as I did, we’d love for you to like and subscribe. Also, head on over to HealthcareITTODAY.com where you can see more great content like this. I’m Colin Hung. Thanks for being here, and I’ll catch you on the next episode.

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