Meeting Our Patients’ Basic Needs

An individual’s health and overall wellbeing is determined by so much more than a medical diagnosis or an annual check-up. These other factors that affect a person’s overall health are called Social Determinants of Health or SDoH. NOAH’s primary patient population, medically undeserved individuals and families, are at a greater risk of their SDoH not being met.

The NOAH team takes SDoH seriously and we work to build a foundation of trust at every stage of patient care to help us understand whether or not our patients’ basic needs are being met.

Watching the video on the right will help you gain a better understanding of SDoH and how health equity is affected by these factors.

Not everyone is comfortable discussing lack of food, housing, safety, work, etc. but as health care providers, it’s critical we start the conversation. As part of our 2022 incentive plan, we’ve committed to a goal of screening 40% increasing to a goal of 70% of NOAH patients for Food Insecurity throughout 2022. Identifying community members who are food insecure gives us the opportunity to connect them with Community Resources for help with obtaining food, income assistance, benefits, etc.

Asking the Questions


NOAH Provider: “Do you have food insecurity?”

NOAH Patient: “Um… no? I don’t think so.”
This only works if the patient understands what “food insecurity” means. Many people do not know that term.


NOAH Provider: “Do you have access to food?”

NOAH Patient: “Yeah.”
This question is easier for all patients to understand, but still may not give a clear answer. The patient may know how to access food but may not be able to afford it or qualify for benefits yet.


NOAH Provider: “Do you know where your next meal will come from?”

NOAH Patient: “My daughter works at a restaurant and she sometimes brings home anything left over from the dinner service.”
This question prompts a response that allows the NOAH staff member to ask additional probing questions and establish trust. At any point in the conversation, a referral can be made to Community Resources who will work with the patient to ensure they have access to resources, benefits, and programs they may qualify for. This might look like a food box from a local food bank and assistance applying for SNAP EBT and unemployment benefits today and help writing a resume and applying for jobs tomorrow.

This is what whole person care means at NOAH and our team continues to make every effort to achieve that level of care for each of our patients. If you have any questions about having these conversations with patients, reach out to the Community Resource Team.

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The Impact of Community Resources – The NOAH Beat

[…] For more information on SDoH and how NOAH helps, see last week’s story “Meeting our Patients’ Basic Needs”. […]

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