New Federal Resources for Factoring Social Determinants of Health into Clinical Practice


Integrating behavioral health and primary care is key to providing the collaborative, patient-centered, and whole-person clinical care needed to address biopsychosocial factors that affect health, well-being, and quality of life and to reduce disparities in health and healthcare. In order to advance health equity, primary care practices and health systems must consider and address social determinants of health (SDOH) and health-related social needs (HRSN) that impact their patients.

Health information technology (IT) systems support the collection, exchange, and use of SDOH and HRSN data. Improving the capacity to share electronic community- and individual-level data on access to food, housing, education, transportation, and other SDOH and HRSN information, can further facilitate the delivery of coordinated, high-quality, person-centered care.

The Office of the National Coordinator for Health Information Technology has released three resources for factoring SDOH and HRSN into clinical practice:

  1. The Social Determinants of Health Information Exchange Toolkit provides approaches for advancing information exchange goals, examples of common challenges and opportunities in information exchange, and questions and resources to inform information exchange implementation.
  2. The Social Determinants of Health Information Exchange Learning Forum brings together healthcare providers, community-based organizations, government, payers, health IT developers, and other partners to share lessons learned, promising practices, and challenges related to exchanging SDOH and HRSN data.
  3. The Social Determinants of Health Clinical Decision Support Feasibility Brief examines the readiness and feasibility for engaging a cross-functional team of healthcare providers, researchers, and health IT developers to evaluate guideline recommendations that reference SDOH for standardized clinical decision support implementation.

The Centers for Medicare & Medicaid Services has also released guidance on offering services, like housing and nutrition supports, as substitutes for standard Medicaid benefits to address HRSN for people with Medicaid coverage.

For more information, see: