Social Determinants of Health - Are you ready for screening requirements?

About the Speaker:

Faith M Jones, MSN, RN, NEA-BC, Director of Care Coordination and Lean Consulting, HealthTech

Faith Jones is the Director of Care Coordination and Lean Consulting for HealthTech. She currently implements care coordination programs focusing on the Medicare population and teaches concepts related to care coordination and team-based approach to care nationally.  Ms. Jones began her healthcare career in the Navy over 40 years ago. She has worked in a variety of roles in clinical practice, education, administration, and consulting. In her leadership roles she has been responsible for the operational leadership for all clinical functions across the healthcare system including ambulatory care and community networking. She has held a variety of leadership positions in the profession of nursing having completed 7 years of service on the American Nurses Association Board of Directors as a Director at Large and the Vice President. She holds a certification from the ANCC as a Nurse Executive Advanced, is a fellow of the American Nurses Advocacy Institute and the ANA-PAC Leadership Society and is certified in Advance Care Planning and Lean for Healthcare.

Summary and Objectives:

In today’s value-based care environment, organizations are accountable for improving health outcomes and lowering costs. To achieve these goals and succeed in such an environment, organizations need to better understand their patients and address the upstream socioeconomic factors that impact patients’ health behaviors, health outcomes, and health costs.  “There is increasing recognition within the health care system of the need to take social determinants of health (SDOH) into account when providing health care services, given that it is estimated that around 50 percent of an individual’s health is directly related to SDOH. Healthy People 2030 define the broad groups of SDOH as: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context, which include factors like housing, food and nutrition access, and transportation needs.”  CMS 2024 Proposed Rules page 206 of 1920 publication 8/7/2023.

This two part series will provide you with an understanding of the SDOH and how to successfully implement it in your practice.  

PART 1 - INTRODUCTION AND SCREENING

Upon completion of the webinar, the participant will understand:
1. The rationale for SDoH screening
2. The use of team-based care in the screening process
3. The difference between screening and assessment

YouTube Recording - Part 1 Links to an external site.

Part 1 Introduction and Screening Handout Download Part 1 Introduction and Screening Handout

PART 2 - ASSESSMENT AND DIAGNOSIS

Upon completion of the webinar, the participant will understand:
1. The various SDoH Z code options
2. The value of gathering and aggregating this data for your practice population.

YouTube Recording - Part 2 Links to an external site.

Part 2 Assessment and Diagnosis Handout Download Part 2 Assessment and Diagnosis Handout

Additional Resources:

SDOH - What is Screening Article Download SDOH - What is Screening Article

PRAPARE Tool - English Version Download PRAPARE Tool - English Version

PRAPARE Tool - Spanish Version Download PRAPARE Tool - Spanish Version

PRAPARE Implementation and Action Toolkit Download PRAPARE Implementation and Action Toolkit

Partnership with the Wyoming Department of Health-Chronic Disease Prevention Program

The Wyoming Center on Aging (WYCOA) is partnering with the Wyoming Department of Health, Chronic Disease Prevention Program, to guide public health professionals and communities in taking action, strengthening capacity, advancing health equity, and engaging in partnerships to reverse the epidemic of diabetes, heart disease, and stroke. The primary aim will be to improve the health of Wyomingites by coordinating information and resources about prediabetes, diabetes, high blood pressure, and high blood cholesterol.

This project/publication is funded by the Wyoming Department of Health and supported by Cooperative Agreement Grant DP23-0020 & DP23-0004 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.