Social Determinants of Health (SDOH)

4/24/20252 min read

Social Determinants of Health (SDOH) refer to the non-medical factors that influence health outcomes. These are the conditions in which people are born, grow, live, work, and age, and they shape the overall well-being of individuals and communities. The World Health Organization (WHO) recognizes that these factors significantly impact health disparities and contribute to differences in health outcomes across populations.

Key Categories of SDOH

Economic Stability

  1. Income level

  1. Employment status

  1. Job security

  1. Poverty levels

  1. Access to financial resources

    Education Access & Quality

  1. Early childhood education

  1. High school graduation rates

  1. Higher education opportunities

  1. Literacy and language skills

  1. Access to quality schools

    Healthcare Access & Quality

  1. Health insurance coverage

  1. Availability of healthcare providers

  1. Affordability of healthcare

  1. Preventive care access

  1. Cultural competence of healthcare professionals

    Neighborhood & Built Environment

  1. Safe housing and neighborhoods

  1. Access to healthy foods (food deserts vs. food swamps)

  1. Exposure to environmental toxins and pollution

  1. Availability of transportation

  1. Crime and violence levels

    Social & Community Context

  1. Social support systems

  1. Community engagement

  1. Discrimination and systemic inequalities

  1. Workplace conditions

  1. Involvement in civic activities

Why Are SDOH Important?

Social determinants contribute to health inequities—the unfair and avoidable differences in health status seen within and between different groups of people. For instance:

  • Individuals living in poverty are more likely to experience chronic diseases.

  • Lack of education can limit job opportunities and access to healthcare.

  • Unsafe living conditions can lead to higher exposure to violence or pollutants.

How Can We Address SDOH?

  1. Policy Interventions – Implementing policies that support living wages, affordable housing, and equitable access to healthcare.

  1. Community Programs – Expanding food assistance programs, literacy programs, and transportation initiatives.

  1. Healthcare System Changes – Training healthcare professionals to consider social factors in treatment and referrals to social services.

  1. Collaboration Across Sectors – Engaging businesses, schools, and governments to create a healthier social environment.

Best Practices for Billing SDOH Assessments

  1. Use a Standardized Screening Tool – Examples include PRAPARE, AHC-HRSN, or WE CARE.

  1. Document Social Risks Clearly – Include findings in the patient record and link them to medical necessity.

  1. Link SDOH to Medical Conditions – Use Z codes alongside chronic disease codes (e.g., diabetes with food insecurity).

  1. Verify Payer Reimbursement Policies – Some insurers reimburse for SDOH screenings, while others require bundled billing.

  1. Consider Value-Based Payment Models – Some programs offer incentives for addressing social risks in care coordination.

Do you need help streamlining this process in your practice? Visit www.triumphmps.net or call 214-305-8805 so our experienced consultants can help.