Sept. 25, 2019
Addressing Patients’ Social Needs Within Health Care Delivery Is Key to Improving Health Outcomes and Reducing Health Disparities, New Report Says
WASHINGTON — Whether a patient has a safe place to live or healthy food to eat has an important influence on their health, but such nonmedical social needs have not traditionally been addressed in routine health care visits. A new report from the National Academies of Sciences, Engineering, and Medicine, Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health, contains five overarching goals and associated recommendations that health care systems, government agencies, and others should implement to better integrate patients’ social needs into health care delivery.Two trends are driving a need to integrate social care with health care, the report says. Firstly, the health care system is moving toward paying care providers based on health outcomes, rather than for individual visits or services. Secondly, there is increasing recognition that addressing the social determinants of health — nonmedical factors such as housing, education, neighborhood safety, and employment — has a profound impact on one’s physical and mental health.“Even if people get the best medical care available to them, they may still have poor health outcomes if other social needs such as housing, reliable transportation, or a strong support system at home are not addressed,” said Kirsten Bibbins-Domingo, a general internist and vice dean for population health and health equity at the University of California, San Francisco, and chair of the committee that wrote the report. “Integrating social care into health care delivery can be transformative for addressing the individual needs of patients and the collective needs of communities. However, we need the workforce, financing, and infrastructure to do this effectively.”Industrialized nations that devote more resources to social services than health care tend to have better health outcomes, the report says. In the United States, for every $1 spent on health care, about 90 cents is spent on social services, while other industrialized countries spend $2 on social services for every $1 spent on health care. Social services constitute a variety of activities — including home-help for the elderly, rent subsidies, child allowances and credits, childcare support, job training, and disability benefits. The challenge of financing the integration of social care with health care in the U.S. is a matter of defining what activities are considered social care, and how they should be paid for, says the report.The report recommends the following steps.Better integrate social care into health care delivery. In order to implement social care more systematically throughout the U.S., health care organizations should:
- Make an organizational commitment to addressing health-related social needs and disparities in individual and population health
- Identify the most effective ways to assess and document social needs, recognizing that evidence for these practices is evolving
- Include social care providers — such as social workers, community health workers, home health aides, and gerontologists — as an integral part of health care teams
- Establish more formal linkages, communication, and financial referral relationships between the health care and social care sectors
Support and train an engaged, integrated care workforce. Social care professionals work in a variety of settings, including health facilities, schools, homes, and community-based organizations. However, certain federal, state, and institutional barriers limit adequate payment of social care workers and their ability to work to the full extent of their education and training, says the report. Social care workforce development efforts should aim to:
- Develop, expand, and standardize the scopes of practice of social care workers
- Create standards for the reimbursement of social care by public and private payers
- Test for knowledge of social determinants of health in licensure exams, continuing education courses, and in other credentialing capacities for health professions such as medicine and nursing
- Adopt curricula that prepare students of social work to use technology, data collection methods, and payment models that facilitate social and medical care integration
Develop an infrastructure for data sharing between health and social care. The report calls for a national vision and defined technology standards for integrating health care and social care data, similar to the standards underpinning the adoption of electronic health records. It recommends:
- The Office of the National Coordinator for Health Information Technology should help states and regions determine the best way to share data necessary for care coordination
- The Federal Health Information Technology Coordinating Committee should facilitate data sharing across sectors including health care, housing, and education
- The U.S. Department of Health and Human Services (HHS) should work with the private sector to disseminate educational tools and guidance on data security and privacy when collecting and sharing personally identifiable information
Finance the integration of health care and social care. The report recommends that the Centers for Medicare & Medicaid Services:
- Define which aspects of social care Medicaid can cover, and make the opportunities and limitations clear to health plans and health care and social care service providers
- Incentivize health care organizations and the managed care programs that contract with Medicaid and Medicare to collaborate with community-based social services, such as Area Agencies on Aging
- Coordinate the coverage and benefits of dually eligible and high-need Medicare and Medicaid populations
In addition, the report says, there are few formal evaluations of the effectiveness of integrating social care needs into health care delivery. Federal and state agencies, foundations, and other funders of research should support timely, robust evaluations that help inform policy. The report also recommends that HHS establish and support a “best practices” repository, to provide stakeholders with lessons learned and examples of effective integration of social care and health care.
The study — undertaken by the Committee on Integrating Social Needs Care into the Delivery of Health Care to Improve the Nation’s Health — was sponsored by the Archstone Foundation; the Association of Oncology Social Work; Bader Philanthropies; Chicago Community Trust; Community Memorial Foundation; the Council on Social Work Education; Episcopal Health Foundation; Health Foundation of Western and Central New York; Healthy Communities Foundation; the Helen Rehr Center for Social Work Practice; Josiah Macy Jr. Foundation; Kaiser Permanente National Community Benefit; the National Association of Social Workers and the NASW Foundation; New York Community Trust; Robert Wood Johnson Foundation; SCAN Foundation; and the Society for Social Work Leadership in Health Care.
Additional support was obtained from the Boston University Center for Innovation in Social Work and Health social work academic program matching funds campaign. For a full list of contributing academic programs, visit the report’s activity page.
The National Academies are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.
Stephanie Miceli, Media Relations Officer
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