2026 executive update · Social needs strategy · Leadership action
Addressing Social Determinants of Health: A Strategic Imperative for Healthcare Executives in 2024
Post ID: 3119 Original publication date: January 8, 2024 Author: Greg Wahlstrom, MBA, HCM Preserved slug: /blog/addressing social determinants health 2024/ 2026 editorial framing: The historical title and date remain…
At a Glance
In 2026, addressing social determinants of health is not a side program for community benefit teams. It is an enterprise responsibility that touches access, quality, patient experience, population health, financial stewardship, and community trust. Healthy People 2030 describes five place based domains: economic stability, education access…
Executive perspective
- Post ID: 3119
- Original publication date: January 8, 2024
- Author: Greg Wahlstrom, MBA, HCM
- Preserved slug:
/blog/addressing-social-determinants-health-2024/ - 2026 editorial framing: The historical title and date remain unchanged. The body below is a current executive guide for 2026.
Internal-link suggestions
Leadership priorities
Build an integrated leadership response
govern priorities with the community, not only for the community
Begin with a limited set of priorities grounded in local evidence. Tax-exempt hospitals already conduct community health needs assessments under federal requirements, but the strategic value of a CHNA depends on how leaders use it. The IRS explains that Section 501(r)(3) requires a CHNA every three years and an implementation strategy. Executives can turn that cycle into a standing governance process rather than a periodic publication exercise.
Create an oversight group that includes operations, clinical leadership, finance, quality, compliance, data governance, community benefit, and representatives of affected communities. Give it authority to choose priorities, allocate resources, define decision rules, and review performance. Community representatives should help interpret data, identify barriers that administrative datasets miss, and test whether proposed services are accessible and respectful. Compensation or other practical support may be appropriate when participation requires meaningful time.
Prioritization should weigh prevalence, severity, inequity, community concern, available partner capacity, and the organization's ability to contribute. Avoid launching a broad screening effort before clarifying what will happen after a need is identified. A smaller, reliable pathway is more credible than a large intake process that creates expectations the organization cannot meet. Each priority should have an executive sponsor, an operational owner, a defined population, a budget, and a review date.
design respectful identification and data governance
Screening should be purposeful, voluntary, understandable, and connected to action. The CMS Accountable Health Communities screening tool offers questions covering core health-related social needs. Its use does not remove the need to decide where screening belongs, who asks the questions, how privacy is explained, and when a person may decline without affecting care.
Map the workflow before placing questions in an electronic record. Define the eligible population, frequency, setting, language options, accessibility needs, escalation rules, and response for each answer. Train staff to explain why information is requested and how it will be used. A person experiencing housing instability or interpersonal safety concerns may reasonably hesitate if the purpose, confidentiality, and next step are unclear. For sensitive concerns, standard referral automation may be inappropriate without a safe conversation and trained response.
Data governance must address collection, access, sharing, retention, correction, and secondary use. Limit access to roles that need the information. Establish standards for structured fields, free text, consent, and exchange with community partners. Monitor missingness and differences in completion across language, race, disability, payer, geography, and access channel. Leaders should also guard against using social-needs data to label patients as noncompliant or to reduce services. The objective is to remove barriers and improve coordination, not to shift responsibility for systemic constraints onto individuals.
build closed-loop partnerships with real capacity
A referral directory is not a closed loop. Reliable coordination requires a current inventory of partners, eligibility requirements, service areas, language capabilities, hours, accessibility, intake methods, and capacity constraints. The CMS guide to using the AHC screening tool emphasizes the difference between health-related social needs and broader social determinants and provides implementation guidance for varied care settings.
Develop written partnership expectations that are proportionate to the relationship. Clarify what information may be shared, how consent is documented, who acknowledges a referral, how urgent needs are escalated, and what happens when a service is unavailable. Do not burden small community organizations with hospital-grade reporting requirements that exceed the value of the arrangement. Offer data support, direct funding, shared training, or simplified contracting when those investments improve capacity and accountability.
Define referral closure in operational terms. A transmitted referral does not establish that a person was reached, eligible, able to attend, or served. Useful statuses may include accepted, unable to contact, waitlisted, ineligible, declined, connected, and alternative arranged. The health system should decide which team retains responsibility at each stage. Partner feedback should inform service redesign, and recurring capacity failures should reach the executive oversight group rather than remaining hidden in care-management notes.
integrate social-needs response into care and operations
The pathway must fit clinical care without making clinicians responsible for solving every social condition. Define roles for registration, nursing, physicians, social work, care management, pharmacy, financial counseling, community health workers, and contact-center staff. Use role-based prompts and escalation rules so the right person receives the information at the right time. When possible, reduce duplicate questions across settings and make prior responses visible with appropriate permissions.
Integration also means aligning operational policies. Transportation support will not solve access if appointment templates are inflexible. Food referrals may have limited effect when medication affordability remains unaddressed. Financial assistance information must be understandable and available before collection activity creates additional harm. Discharge plans should reflect whether the person has a safe place, necessary utilities, caregiving support, and a realistic way to obtain follow-up care.
measure access, reliability, equity, and learning
Measure the pathway, not just the number of screenings. A balanced dashboard can include the eligible population reached, acceptance and decline rates, identified needs, time to response, referral acceptance, connection rate, time to service, unresolved needs, and patient-reported helpfulness. Stratification can reveal whether the process reaches and benefits populations equitably. Measures should be interpreted with context because a higher identification rate may reflect improved trust or a change in screening reach, not worsening community conditions.
Pair process measures with outcomes that are close enough to the intervention to support responsible interpretation. Examples include kept appointments after transportation assistance, medication access after financial navigation, or completion of follow-up after a coordinated referral. Avoid attributing broad clinical or cost outcomes to a single intervention without an appropriate evaluation design. Finance and analytics teams should document assumptions, comparison methods, data limits, and unintended consequences.
Leadership cadence
Start, strengthen, and measure the system in 90 days.
Start: days 1 through 30
Name an executive sponsor and operational owner. Select one priority population and one or two needs using CHNA findings, operational data, and community input. Map the current workflow from identification to service. Inventory partner capacity, review consent and privacy practices, and establish a baseline for reach, response time, connection, and unresolved need. Do not expand screening until the response pathway is defined.
Strengthen: days 31 through 60
Co-design the workflow with staff, patients, and community partners. Standardize scripts, role assignments, escalation rules, referral statuses, and fallback options. Configure only the minimum necessary technology. Train affected roles with scenarios, test the pathway in a limited setting, and hold rapid reviews of failed handoffs. Resolve contracting or funding barriers that make community capacity unreliable.
Measure: days 61 through 90
Review reach, completion, identified need, referral acceptance, connection, time to service, and patient-reported usefulness. Stratify results and examine reasons for decline or failure. Approve corrective actions, confirm the next 90-day scope, and report decisions to executive leadership and the community oversight group. Scale only after the pilot demonstrates a respectful and dependable response.
Decision-grade measurement
Metrics that belong on the executive dashboard
- Percentage of the eligible population offered identification and percentage choosing to participate
- Time from identified need to human response and to accepted referral
- Referral connection rate, unresolved-need rate, and documented fallback rate
- Patient-reported respect, clarity, privacy, and usefulness
- Differences in reach and connection by population, location, language, disability, and access channel
- Partner capacity, wait time, referral rejection reasons, and funding stability
- Improvement actions completed on time and evidence reviewed after implementation
Conclusion
Turn strategy into an accountable operating system.
Social determinants of health require humility about what a healthcare organization can control and discipline about what it promises. Executives create value when they connect community priorities, respectful identification, capable partners, operational workflows, and transparent measurement. Screening without response can erode trust, while partnerships without capacity can shift work to already constrained organizations.
The practical 2026 mandate is to build one dependable pathway, learn from its failures, and scale only when people can reach support equitably. A governed system makes social-needs work visible to operations and the board, protects individuals from unnecessary data collection, and converts good intent into accountable action.
Executive questions
Frequently asked questions
What is the difference between social determinants of health and health-related social needs?
Social determinants are the broader conditions in which people live, learn, work, and age. Health-related social needs are individual-level concerns, such as transportation or food insecurity, that may be identified and addressed through a care pathway. The distinction helps leaders avoid presenting screening as a solution to structural conditions.
Should every patient be screened in every setting?
Not automatically. Leaders should define the purpose, eligible population, frequency, response capacity, consent process, and escalation pathway first. A universal approach may be appropriate in some settings, but repeated or unsupported screening can create burden and weaken trust.
Who should own the strategy?
An executive sponsor should be accountable for enterprise alignment, while an operational owner manages the pathway. Community partners, patients, clinicians, care management, data, privacy, finance, quality, and compliance should share defined responsibilities.
How should executives evaluate financial value?
Track implementation cost, partner investment, service use, and outcomes close to the intervention. Document assumptions and avoid claiming savings without a credible method. Financial value should be considered alongside access, equity, experience, and community benefit.
