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Unlocking the Social Determinants of Health

IDC Technology Spotlight

In the healthcare industry, fragmented care results in fragmented data. Healthcare organizations need clean, actionable data. A single longitudinal patient record that integrates financial, clinical, behavioral, social, and human services is required to manage high-risk patients.


The benefits of integrated social, human, behavioral, and clinical care are well documented in academic literature. The time is now for healthcare organizations to apply those learnings to the management of their highest-risk patients. It is only by taking a holistic approach to care that measurable progress can be made to improve clinical and financial outcomes. The key to success lies in the data — the requirement for clean longitudinal patient data is clear.

It is well documented and accepted that clinical care has only a small impact on an individual's health. The demands of at-risk contracting as well as the costs to the healthcare system of opioid addiction, poor housing, food insecurity, and other environmental factors demand a holistic approach to health management.

This IDC Technology Spotlight explores the creation of a comprehensive longitudinal care record that includes financial, clinical, behavioral, social, and human services data. To create clean, actionable data, healthcare organizations must overcome the complexity of a fragmented healthcare ecosystem and an external environment suffering from the same challenges.

Demand for Social Determinants of Health Data Grows Despite Complexity

A key element in the transformation to a value-based healthcare system is the holistic management of patients by integrating services across the spectrum of care. Episodic clinical care in isolation is not improving health or managing escalating expenses in any meaningful way; the integration of an individual's clinical, behavioral, social, and human insufficiencies is a necessity. Yet while many in the industry accept the benefits of integrated care, few have met the challenges of using integrated data to drive program design.

The academic literature is full of studies showing the positive impact on health outcomes from providing appropriate social and human services integrated with clinical care. Providing such services is the objective of many though few have delivered programs at scale that demonstrate sustainable improvements. Access to robust patient data to understand which services will deliver the best outcomes for individuals is key to long-term sustainable results.

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