Three in Four Community Health Centers Are Engaged in Social Determinants of Health Activities. Making These Activities Universal Will Require Greater Investment and Payment Flexibility.

Peter Shin, Jessica Sharac, Feygele Jacobs, and Sara RosenbaumExecutive Summary Poverty, lack of safe, affordable housing, hunger and poor nutrition, exposure to domestic violence, and other social conditions all have been shown to deeply affect both short- and long-term health outcomes. For over five decades, community health centers have been engaged in efforts to identify their patients’ social and health risks and to help fashion responsive solutions. Using information from HRSA’s 2020 nationwide Uniform Data System (UDS), this Data Note examines the extent of community health center involvement in systematic efforts to screen patients for the presence of one or more social determinants of health (SDoH). Based on the reported data, we characterized health centers as being engaged in SDoH activities if the health center reported collecting data on patients’ individual social risk factors, the health center indicated that it utilized one or more standardized social-risk screeners, and/or the health center reported any data on the number of patients who screened positive for social risks.Key Findings • Based on our definition of SDoH engagement, three in four (75 percent) health centers in 2020 were engaged in SDoH activities. This is a higher share than the nearly seven in ten (69 percent) health centers that reported collecting data on patient social risks in the 2020 UDS.• Nearly half (47 percent) of health centers reported using a standardized social risk screening tool, considered important for completely and accurately collecting information on health risks.• Six in ten health centers that reported collecting data on patients’ individual social risks also reported using a standardized screener.• Health centers reported nearly 790,000 patients who screened positive for financial strain, and approximately 495,100 patients screened positive for food insecurity, 412,000 for housing insecurity, and 303,000 for lack of transportation or access to public transportation.• Health centers engaged in SDoH activities were significantly more likely to be larger, urban, located in a Medicaid expansion state, and to show greater Medicaid participation. Conversely, SDoH screening appeared to pose greater challenges for smaller health centers that were more reliant on health center grant funding and practicing in non-Medicaid expansion states – ironically, states whose residents are at especially high risk of poverty and burdened by poor health.Reaching the goal of universal health center social risk engagement will require targeted grant support as well as Medicaid performance investments aimed at more fully reflecting the range of costs associated with social risk screening and reporting.This data note is available here.