It used to be that when a receptionist gave you a form to fill-out at a doctor’s office, the questions were about medical issues, such as whether you’re allergic to anything or are up to date on your vaccines.
But some health organizations are now asking much more general questions: Do you have trouble paying your bills? Do you feel safe at home? Do you have enough to eat?
At first glance, such issues may seem to have little to do with health. But experts now think they can be as important to your health as your exercise habits or whether you get enough sleep.
Factors Impacting Premature Death
Source: Kaiser Family Foundation
Some doctors even think your zip code is as important to your health as your genetic code.
That’s why Shannon McGrath was asked to fill-in a “life situation form“ this spring when she turned up for her first obstetrics appointment at Kaiser Permanente. She was 36 weeks pregnant.
“When I got pregnant I was homeless,” she said. “I didn’t have a lot of structure. And so it was hard to make an appointment. I had struggles with child care for my other kids, transportation, financial struggles.”
The ‘life situation’ form asked about her rent, her debts, her child care situation and other social factors. On the strength of her answers, Kaiser Permanente assigned her what’s called a “patient navigator.”
“She automatically set up my next few appointments and then set up the rides for them, because that was my No. 1 struggle,” McGrath said. “She assured me that child care wouldn’t be an issue and that it would be OK if they came. So I brought the kids and everything was easy, just like she said it would be.”
McGrath got help with rent, with a phone and essentials for the baby — such as diapers and bottles — all in the hope that making her life easier might keep her healthier and in turn keep Kaiser’s medical costs lower.
McGrath says her patient navigator, Angelette Hamilton, was a bureaucratic ninja, removing paperwork obstacles that kept her from taking care of herself and her family.
But patient navigators have been around for a while. What’s new for this story is that “life situation form” McGrath filled out and how hospitals are using socioeconomic and other data to serve patients. They’re putting such details into patient files, which means providers such as Dr. Sarah Lambert have more information at a glance.
“I find it incredibly helpful because it can be very hard to find out,” said Lambert, who works at Kaiser Permanente Northwest. “Having it coded right there — we have this problem list that jumps up — really can give you a much better understanding as to what the patient’s going through.”
Federal officials introduced new medical codes for the social determinants of health a few years ago, said Cara James, director of the Office of Minority Health at the Centers for Medicare and Medicaid Services.
“What is changing is that more providers are beginning to recognize the impact that the social determinants have on their patients,” she said.
Nicole Friedman with Kaiser Permanente Northwest agrees. But she goes one step further.
She hopes giving doctors more information about their patients’ home lives will push health care in a completely new direction.
“My personal belief is that putting more money into healthcare is a moral sin,” she said. “We need to take money out of health care and put it into other social inputs like housing and food and transportation.”
She said linking health organizations like Kaiser with non-medical nonprofits such as the Oregon Food Bank will help governments and medical providers see where their money can make the biggest difference.
For example, spending more on affordable housing for homeless people can also have health benefits — in turn saving the government money down the line.one study found a 40 percent reduction in emergency room utilization.
McGrath was skeptical when doctors offered to help her with things like rent and transportation.
“I didn’t want someone to see my situation and have it raise alarms,” she said.
But she said she was pleased she opened up to Kaiser because it made her more likely to seek the help she needs.
“I’m able to look at life and not feel overwhelmed or burdened or like I’ve got the whole world on my shoulders,” she said.