Health is determined by more than just medical care. Research shows that the social determinants of health—the conditions in which people are born, grow, live, work and age—are of even greater importance.
Including factors such as education level, socioeconomic status, food availability, language, culture, and even how much green space is in one’s neighborhood, these conditions have twice the impact on health status as medical care. Yet in spite of their obvious prominence in the health equation, the healthcare system isn’t well organized to take them on, nor are they treated with the same level of importance. In fact, the US spends significantly less on social services per healthcare dollar spent than any other country of comparable GDP—$0.56 versus an average of $1.70.
Why integration is key for addressing social determinants of health
Everything about the US healthcare system is complex, from the problems it’s required to solve to the regulations intended to promote care quality, cost effectiveness and access. Its fragmented nature is particularly problematic as providers seek to address social determinants of health. How can they address barriers to health like housing or food insecurity when the systems designed to address these factors remain separate? This disconnect often puts the onus on patients to figure out how to address these non-medical, health-related needs. Unfortunately, many patients may not even be aware that there are services or tools available to help. In circumstances where providers are ill-equipped to address the full range of their patients’ health needs, health systems must strive to align their processes and resources with those who can—for instance social workers, housing organizations, etc.
Our research on innovation in other industries speaks to the power of integration in these circumstances. Specifically, we’ve found that when performance isn’t yet good enough to address the needs of a particular customer segment—for instance, those who lack stable housing or have significantly lower income—firms must integrate. In other words, they must control the entire service design and production process in order to make sure all the components work together as intended.
This is necessary because unpredictable and complex interdependencies exist between components of a “not-good-enough” service. They’re not like jigsaw puzzle pieces, designed to fit together in obvious ways so that anyone can join them up, even without knowing the picture they’re constructing. Hence the managers who own each component—in this case, medical care, social services, etc.—must collaborate closely to align their respective designs so that they fit and work together in a way that optimizes overall product performance.
But how can it be done? Recently, policymakers passed legislation to better integrate care for Medicare-Medicaid beneficiaries and to address non-medical benefits, demonstrating momentum surrounding social determinant integration. As they seek to build on much-needed initiatives like these, they can look to three organizations that seem to be getting integration right:
Hennepin Health is a safety-net accountable care organization (ACO) operating in Hennepin County, Minnesota, targeting high-risk Medicaid patients with a number of chronic health and social needs. To address issues ranging from homelessness to mental illness, the ACO has integrated several relevant organizations into a single partnership: the county’s local Human Services and Public Health Department, a local teaching hospital, a Medicaid managed care health plan, and a Federally Qualified Health Center.
Providing nonmedical services is deeply ingrained in their model. For instance, Hennepin patients are automatically provided housing at Hennepin County-run group residential housing before receiving medical treatment, in recognition of the simple fact that housing is often necessary for improved health. Incorporating the all-important need of housing security as part of the care process has been one of Hennepin’s greatest investments, and has helped to contribute to the dramatic decrease of ER usage among patients.
2. One Care
One Care, a Massachusetts-based program run in part by Commonwealth Care Alliance, focuses on low-income patients with disabilities under age 65 who qualify for both Medicare and Medicaid. Given the program focuses on those with severely high needs, it recognizes the need to not only offer quality medical care and mental health services, but also coordinate long-term and continuous support services such as securing accessible housing, and helping to find social activities for isolated patients.
To address nonmedical needs, One Care employs personalized, comprehensive care teams consisting of social workers and community health workers alongside a broad network of medical professionals. Their model allows One Care to customize care teams depending on the specific needs of the patient, as well as fully incorporate and approve nonmedical benefits that significantly impact health (such as food, air conditioning, and cleaning services).
One problem with modular solutions to social determinants is that patients do not always have the knowledge or means to seek out the services they need on their own. CVS announced last week that it is rolling out a platform designed to address that challenge, by providing an online tool that integrates all of these services into one platform. Called “Destination: Health,” the new platform, created with social care coordination platform Unite Us, connects Aetna-insured Medicaid and dual-eligible patients with a network of community-based social service providers. While we’ve yet to see whether patients find the tool useful, it’s an interesting example of how organizations can leverage technology to bridge gaps in healthcare.
In last month’s first fiery democratic debate, Cory Booker (D-NJ) acknowledged the interconnectedness between our health, employment, education, and more. It’s promising to see this topic finally gaining prominence in the national dialogue, so long as campaign promises lead to sound policy. To that end, policymakers can learn from initiatives like these that are thoughtfully integrating healthcare services with non-medical services, and providing solid stepping stones into a future where social determinants are considered just as integral to health outcomes as medical care.
