Serving Social Complexity

Lessons learned from supporting our most vulnerable patient populations

As I’ve been shadowing and volunteering in a number of healthcare institutions over the past year, I’ve found that types of providers that I support seem to fall into a 2-by-2 framework:

  1. EDs often see the most socially and medically complex patients and is where the bulk of healthcare costs lie.
  2. ICUs see patients that have difficult co-morbidities (often in post-operative states) but have a higher proportion of patients that can be safely discharged to home or an appropriate level of step-down care.
  3. The majority of PCP visits are focused on the already healthy patients that have a stable social determinants that facilitate regular-enough engagements with their PCP. Telemedicine caters to a similar population that can afford the technology and has the type of clinical conditions that can be served through remote consultation.
  4. The most underserved patient population are those with high social but low medical complexity. Without a clear clinical prompt, these patients aren’t engaged in enough preventative care and are prohibited by social determinants (e.g., housing placement, transportation access, prioritizing food insecurity) from accessing the frontlines of healthcare until its too late.

This framework illuminates the importance of community-oriented clinics like the Family Van and Boston’s Healthcare for the Homeless Program — institutions I’ve had the privilege of volunteering for specifically in the context of patients in quadrant #4 above. As public health research has consistently shown, social complexity catalyzes the exacerbates medical complexity over time:

the unfortunate (but natural) progression for patients struggling with social determinants of health

Localized investments like mobile clinics and community health workers have an outsized impact on socially complex patient populations. However, they prove only effective if they can intervene timely (and culturally integrated) manner. As I’ve learned from Dr. Krishna Yeshwant, it’s incredibly difficult to innovate and scale services to support this vulnerable patient population. Technology and medicine both have different strengths in breadth and depth but perhaps a synergistic partnership may lead to lasting and sustainable ways to support these patient populations.