Social determinants of health: access and care | myNEXUS®

22 . 12 . 2021

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Our industry continues to concentrate on social determinants of health (SDOH) which can dramatically influence the health and well-being of people within our communities.

In this third part of our series on Social Determinants of Health (SDOH), we explore how access to healthcare is essential for better health. Unfortunately, access often relies on the zip code a patient lives in which can influence the availability of primary care providers, public and private transportation, and insurance coverage.

Primary care

Research conducted by the CDC shows that “access to primary care is associated with positive health outcomes. Because primary care providers offer preventive care services for earlier detection and treatment of health concerns, lack of access to primary care can lead to more advanced illnesses and the need for more acute treatment, including emergency room visits and hospitalizations.

For many Americans, however, finding a primary care provider within their health plan’s network, who is conveniently located, and is available for scheduled and urgent appointments, is a challenge. According to data published by the Association of American Medical Colleges (AAMC), it is estimated that the United States could see a shortage of between 37,800 and 124,000 physicians by 2034, including shortfalls in both primary and specialty care.


Once able to schedule an appointment, transportation to and from that appointment can be a challenge for patients as well as the care managers and social workers who assist them in obtaining rides. Transportation barriers include the distance from a provider’s office, the density of available providers in a given area, the time needed to get to and from appointments, the availability of rides and caregivers, and the cost of transportation. These issues tend to be amplified in underserved areas where many patients already struggle to find access to care.

Health insurance coverage

Lack of insurance often leads to poor access to healthcare and longer delays for treatment as uninsured adults are more likely to forgo medical treatments rather than risk a financial burden. Healthy people states that “vulnerable populations are particularly at risk for insufficient health insurance coverage; people with lower incomes are often uninsured, and minorities account for over half of the uninsured population. One study found that in 2015 among adults aged 18–64, 12.8% were uninsured, 18.9% had public coverage, and 69.7% had private health insurance coverage.

Events over the past several years have demonstrated that access to healthcare can be as much if not more of a challenge than language barriers, financial hardship, lack of education, and even a mistrust of the healthcare system.

myNEXUS is working to address these challenges, especially for the Medicare Advantage patients we serve, who may be struggling with access to care in many of these areas. Our social determinants of health program works to identify and mitigate health access issues for patients, helping them live healthier lives. We continue to partner with health professionals across the US to ensure adequate coverage for our patients regardless of where they live.

Understanding social determinants of health

The term, “social determinants of health” refers to environmental and community barriers to quality care. In our SDOH series, we’re covering the areas that reflect those barriers most often, as outlined by the CDC. Read more about the social determinants of health in our library or bookmark our SDOH resources page to see how myNEXUS is helping to overcome these barriers and improve patient outcomes in the home.

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