Major new report calls for better integration of social determinants of health

Providers nationwide need to make an organizational commitment to addressing social needs and health disparities, says the National Academies of Sciences, Engineering, and Medicine – and policymakers need to sort out IT infrastructure and reimbursement.
By Mike Miliard
02:27 PM

The National Academies of Sciences, Engineering, and Medicine has published a new study that explores some key imperatives for health systems, government agencies and other stakeholders with regard to addressing the social determinants of health.

The report, "Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health," offers recommendations as the U.S. healthcare system recognizes that nonmedical factors such as housing, food security, transportation, education, loneliness, domestic safety, employment status are essential contributors physical and mental health.

The National Academies say SDOH data needs to be better integrated more systematically into healthcare delivery, and that providers should make organizational commitments to addressing these factors.

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Health systems should work to identify the most effective ways to assess and document social needs, and make efforts to include social workers, community health workers,  home health aides, gerontologists and others in their care teams.

Still, too many federal, state, and institutional barriers are standing in the way of adequate payment of social care workers and hinder their ability to work to the full extent of their training, according to the report, which calls for more robust workforce development programs to create standards for the reimbursement of social care by public and private payers, among other recommendations.

Crucially, the NASEM study also emphasizes the need for a more widespread infrastructure to share data among healthcare providers and community groups. It calls for defined technology standards for integrating SDOH data, and says the Office of the National Coordinator for Health IT should help states and regions determine the best way to share data necessary for care coordination the report recommends.

In addition, the Federal Health Information Technology Coordinating Committee should facilitate data sharing across sectors including health care, housing and education and 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."

Meanwhile, the Centers for Medicare & Medicaid Service should be more explicit about 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, researchers said.

CMS should also incentivize healthcare organizations and managed care programs to collaborate with community-based social services and coordinate the coverage and benefits of dually eligible and high-need Medicare and Medicaid populations.

In addition, "federal and state agencies, foundations and other funders of research should support timely, robust evaluations that help inform policy," according to the report. "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 National Academies study points out that countries that devote more resources to social services than health care tend to have better health outcomes: "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 healthcare."

The NASEM report comes the same week as one study showing that investing earlier in addressing social determinants could save money for health systens in the long term while also improving outcomes – and another that reveals Medicare Advantage plans are only making limited use of new supplemental benefit flexibility provided by CMS to help address SDOH needs.

"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 Dr. Kirsten Bibbins-Domingo, vice dean for population health and health equity at the University of California, San Francisco.

"Integrating social care into health care delivery can be transformative for addressing the individual needs of patients and the collective needs of communities," she said. "However, we need the workforce, financing, and infrastructure to do this effectively." 

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