Social Determinants of Health: The Nutrition Effect Part 2

Part 1 of Social Determinants of Health – The Nutrition Effect discussed how diet has a major impact on population health because of how it integrates with SDOH whereby poor health can be traced back to a compounding of issues including economic hardship, poor access to healthcare, lack of health education, mental health issues, or even cultural beliefs.  The next question is, “How does that impact Accountable Care Organizations?”

ACOs were created out of necessity to care for patients with complex, chronic conditions who frequently burden the healthcare system with high expenditures and utilization. The American Diabetes Association says that 9.4% of Americans, or over 30 million people, are currently living with diabetes (much of which is nutrition-related). Other statistics show that diabetes causes more deaths per year than breast cancer and AIDS combined, and having diabetes nearly doubles your chance of having a heart attack.

CMS states that in 2017 about 2.3% of Medicare beneficiaries had type 1 diabetes while 18.9% had type 2. Another 6.6% are prediabetic, meaning that nearly 28% of the beneficiaries in the MSSP program are dealing with some form of diabetes. Over 70% of those patients are dealing with other chronic conditions such as hypertension, obesity, or nonalcoholic fatty liver disease. This ties directly back to the nutrition issue. If a beneficiary has poor nutrition and they have trouble making it to see their primary care physician (SDOH), then you start to see the compound effect of Social Determinants of Health and Diabetes can have for ACOs.

The major takeaway from all of this is that the food we put in our bodies has a massive impact on our overall health. If you want to lower the cost of healthcare in the United States, it’s worth first considering what is on the dinner table, and why that’s on the dinner table for much of the country’s population before providers start prescribing expensive drugs and procedures.

Zoraime Ramos Cortes is a Public Health Nutritionist Supervisor for the Florida Department of Health. Having previously been on staff as a dietitian at Wellington Regional Medical Center, she sees, first-hand, the interaction between SDOH, diet, and inpatient admissions. “For many health conditions, diet is at the root cause of disease states. What we put into our mouths throughout each day, will have a major impact on our health outcome for years to come. Unfortunately, social determinants of health also play a major factor in our health, at times, dictating what foods or resources will be available to certain populations for consumption,” says Ramos Cortes.

“For example, as a population, practitioners are beginning to see disease states, such as hyperlipidemia, hypertension, Type 2 Diabetes, and obesity become leading causes of death, and even emerge in children as young as 5 years of age; chronic illnesses which were typically seen in middle aged adults.”

Public Health Nutritionist Supervisor Zoraime Ramos Cortes eats guacamole, which is made from avocados, a “superfood” for its nutritional benefits.

Ramos Cortes also mentioned that healthy, affordable foods are becoming less available to particular populations, many of which reside in food deserts. If your ACO is in a food desert, that will have a massive impact on overall quality measures.

ACOs don’t always have dietitians under their stead, but it’s practicing good population health if they begin discussing the possibility of bringing dietitians into their networks to get out in front of health issues before they become too problematic. By promoting diet education among their patients, those whom don’t have diabetes are less likely to acquire it later in life. Those whom do live with diabetes can better manage their disease before cataracts, glaucoma, kidney disease, and diabetic heart disease set in, significantly increasing the cost of care as the patient’s health deteriorates. If ACOs can get their patients to see their PCPs for Annual Wellness Visits, have them regularly check their HbA1c, get them in for diabetic retinal screening, and educate them on proper nutrition, it won’t fix everything. However, it will go a long way towards practicing good population health and easing some of the stressors on the American healthcare system. It’s a long road to get where we want healthcare to be, but at least we now know there’s a path available to us.


Ryan Mackman

About the Author


Ryan Mackman, MBA, MHA - Business Consultant

Ryan Mackman has been an ACO business consultant team member with Salient since March 2018. In this role, he acts as a solution trainer, marketing and sales consultant, as well as Value Based Payment strategist. His skillset helps augment Salient’s efforts at the ACO and physician practice level. Prior to joining Salient, Mr. Mackman spent four years as the Business Administrator and Project Manager for Premier Family Health, a Level 3 Patient Centered Medical Home near West Palm Beach, FL. Mr. Mackman holds a Master’s in Business Administration and a Master’s in Health Administration from Florida Atlantic University. He received his Bachelor’s degree from the University of Florida. He currently holds a Six Sigma Green Belt Certification and is a member of the American College of Healthcare Executives.

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