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The Role of Social Determinants of Health in Integrated Care

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By KBRAX
2/6/2025
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In today’s healthcare landscape, delivering effective care goes beyond treating symptoms or managing chronic conditions. It requires addressing the whole person—body, mind, and environment. This is where Social Determinants of Health (SDOH) come into play.

SDOH are the conditions in which people are born, grow, live, work, and age. These factors—such as housing, education, employment, and access to healthy food—have a profound impact on health outcomes. In fact, research shows that up to 80% of health outcomes are influenced by SDOH, while only 20% are tied to clinical care.

For healthcare organizations, integrating SDOH into care delivery isn’t just a nice-to-have—it’s a must-have. Here’s why.

Why Social Determinants of Health Matter

  • They Reveal the Full Picture 
    A patient’s health isn’tdetermined solely by medical history or genetics. Factors like unstable housing, food insecurity, or lack of transportation can create barriers to care and worsen health outcomes. By understanding these factors, providers can deliver more personalized and effective care. 
  • They Drive Health Equity 
    Disparities in healthcare access and outcomes are often rooted in social and economic inequities. Addressing SDOH helps level the playing field, ensuring that all patients—regardless of their background—have the opportunity to achieve better health. 
  • They Reduce Costs 
    Ignoring SDOH can lead to higher healthcare costs. For example, patients without reliable transportation may miss appointments, leading to untreated conditions and costly emergency room visits. By addressing these barriers, organizations can improve outcomes while reducing unnecessary spending. 

How Integrated Care Models Address SDOH

Integrated care models, like Collaborative Care (CoCM) and Integrated Behavioral Health (IBH), are uniquely positioned to address SDOH. These models bring together physical health, mental health, and social services under one umbrella, creating a holistic approach to care delivery.

Here’s how integrated care can make a difference:

  • Screening for SDOH 
    The first step is identifying social determinants that impact a patient’s health. Tools like CareCompanion® use meaningful, interactive conversations to capture critical data, including symptoms, mood, lifestyle factors, and more. This comprehensive dataset provides a holistic view of the patient’s health, enabling providers to tailor interventions effectively. 
  • Care Coordination 
    Once SDOH areidentified, care teams can connect patients with community resources. CareNavigator streamlines this process by managing care plans, tracking progress, and optimizing resource allocation. By addressing both mental health and physical health concerns, CareNavigator helps prevent barriers to treatment adherence and recovery. 
  • Real-Time Insights 
    Platforms like CompleteCarePlatform® provide real-time data and analytics, enabling providers to track SDOH interventions and measure their impact. This ensures that care plans are data-driven and patient-centered, while also supporting Collaborative Care Models (CoCM) and Integrated Behavioral Health (IBH). 
  • Patient Engagement 
    Empowering patients to take an active role in their health is key. Tools like MindPure® take a holistic approach to mental health, addressing symptoms as well as underlying factors like nutrition, sleep, and relationships. With patient-centric engagement, MindPure® ensures that interventions are tailored to individual needs and preferences, meeting patients where they are in their care journey. 

The KBRAX Approach: Whole-Person Care in Action

At KBRAX, we believe that addressing SDOH is essential to delivering whole-person care. Our CompleteCarePlatform® seamlessly integrates physical health, mental health, and social determinants of health into a single, unified platform.

Here’s how we’re helping healthcare organizations tackle SDOH:

  • Dynamic Care Journeys: Our CareNavigator tool enhances care coordination, ensuring patients receive the support they need—whether it’s medical care, mental health resources, or social services.
  • Predictive Analytics: By analyzing SDOH data, we help providers identify at-risk patients and intervene early.
  • Community Partnerships: We connect healthcare organizations with local resources, creating a network of support for patients.

The Future of SDOH in Healthcare

As healthcare continues to evolve, addressing SDOH will become even more critical. Organizations that embrace integrated care models and leverage technology to tackle social determinants will be better positioned to:

  • Improve patient outcomes.
  • Reduce healthcare costs.
  • Advance health equity.

At KBRAX, we’re proud to be at the forefront of this movement, empowering healthcare organizations to deliver better care for every patient, every time.

Ready to see how KBRAX can help your organization address social determinants of health and deliver whole-person care? Contact us today to learn more about CompleteCarePlatform® and our suite of innovative solutions.