CCE Quarterly: Social Determinants in the Medical Home

Cost: $99.00
Duration: 1.5 hours

CCE Quarterly: Social Determinants of Health in the Medical Home OnDemand

Social determinants of health (SDOH) are conditions of environment—where people are born, live, learn, work, play, worship and age—that affect a wide range of health, functioning and quality-of-life outcomes and risks.

There is broad agreement that SDOH have significant impact on health care outcomes. Patients need more than clinical treatment to recover from illness and stay healthy. Improving patients’ home lives and meeting their basic social needs might be as important as traditional care—or it might be even more important.

NCQA has identified SDOH as a special topic for Annual Reporting in 2020–2021. The core criteria in Knowing and Managing Your Patients (KM) require practices to routinely collect comprehensive patient data, to use that data to understand patients’ backgrounds and health risks and to deliver evidence-based, culturally and linguistically appropriate care that meets population needs.

This webinar will explore strategies for collecting comprehensive patient data and will outline practices for incorporating SDOH into risk stratification. Faculty will discuss how to screen patients, monitor at the population level and implement care interventions based on collected data.


Target Audience

  • CCE's.
  • Consultants.
  • Primary Care Teams.
  • Practice Managers. 
  • Health Plans.
  • Physicians
  • Nurses
  • PAs
  • Pharmacists

Learning Objectives

At the conclusion of the webinar, participants will be able to:

  • Identify where SDOH are incorporated into PCMH Recognition criteria.
  • Articulate why SDOH was selected as a special topic for Annual Reporting.
  • Outline methods of collection for SDOH data.
  • Develop a plan for how to incorporate SDOH characteristics into risk stratification and care management.
Course summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 ANCC
  • 1.00 IPCE
  • 2.00 Participation
  • 2.00 PCMH CCE
Course opens: 
Course expires: 

Bri Clifford, MPH, PCMH CCE

Bri Clifford is a Policy Manager in NCQA’s Recognition Programs Policy and Resources Department. On this team she supports recognition programs through the creation of resources, maintenance of programs and education of both internal and external stakeholders.

Before joining NCQA, she worked with the United States Department of Health and Human Services Office of Emergency Management. There she helped create a GIS mapping tool used to track patient movement to HHS staffed medical facilities in response to natural disasters. She also spent three years managing the clinical side of specialty practices and volunteering as an EMT in her community.

Bri holds a BS in Biology from Virginia Tech and an MPH in Epidemiology from George Mason University.

Samantha Sawdon, PCMH CCE

Ms. Sawdon is the principal consultant at Synergistic Strategies LLC. She is an experienced professional with the ability to manage operations, implement change, processes and people. She has expertise in managing enterprise-wide health information technology projects, including coordination of stakeholder and vendors, project research, specifications, and deliverables, implementation strategies, user application definition and workflow design, validation processes, quality assurance, and support. She has strong leadership skills to focus her teams on project timelines and deliverables. Prior to starting her own company, Ms. Sawdon worked as a Managing Consultant for Massachusetts eHealth Collaborative and was a Practice Manager for major hospitals in the Boston area. She managed the Senior Health Care practice at Massachusetts General Hospital, a Multi-Specialty practice at St. Elizabeth’s hospital and the Cardiology and Vascular Surgery Departments at Boston Medical Center.  Ms. Sawdon holds a degree from  University of New Hampshire and has been a PCMH CCE for five years.


In support of improving patient care, the National Committee for Quality Assurance is jointly accredited for Continuing Medical Education (ACCME), the  American Nurses Credentialing Center (ANCC) to provide Interprofessional Continuing Education for the healthcare team. 

This educational activity is approved for: 1.0 AMA PRA Category 1 Credit™.

This educational activity is approved for 1.0 nursing contact hours.*

This live webinar grants 2.0 required Continuing Education Unit (CEU) points for PCMH Certified Content Experts.

* Please note – You must attend the entire program to be eligible for total number of contact hours. 

ATTENTION: Effective February 1, 2022, this on-demand (enduring material) activity no longer offers credits for the American Academy of Physician Assistants (AAPA), the American Psychological Association (APA), or the Association of Social Work Boards (ASWB). Only applicable professionals who fully completed this on-demand activity prior to February 1, 2022, are eligible for AAPA, APA, or ASWB credits. No other CEUs are impacted by this change

Available Credit

  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 ANCC
  • 1.00 IPCE
  • 2.00 Participation
  • 2.00 PCMH CCE


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