Whether a patient has a safe place to live or healthy food to eat has an important influence on their health, but routine health care visits have not traditionally addressed these non-medical, social needs.
A new report from the National Academies of Sciences, Engineering, and Medicine (NASEM), Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health, contains 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.
Sean Joe, Benjamin E. Youngdahl Professor of Social Development and associate dean for faculty and research at the Brown School, was one of 17 committee members from around the nation who helped to inform and develop the report. A nationally recognized expert on mental health, suicidal behaviors and social mobility in African-Americans, he worked among a team that included other social work scientists; physicians; nurses; gerontologists; and insurance, policy and technology leaders.
“There is recognition that factors such as housing, education, neighborhood safety, and employment have a very profound impact on one’s physical and mental health, and yet our health care system is not equipped to address these needs,” Joe said. “This report offers a comprehensive review of the evidence and practices related to this issue, and provides ways to move forward.”
Industrialized nations that devote more resources to social services than health care tend to have better health outcomes, the report states. 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.
The report identifies key workforce, technological and policy priorities, Joe said. For example, social workers and other social care workers—community health workers, peer specialists—should be considered providers who are eligible for reimbursement. Public and private payers should create standards for the reimbursement of social care, including assessment and such treatment as chronic care management, behavioral health integration, and transitional care management.
“It is clear that the Brown School, with programs in social work, public health and social policy, along with Washington University, is uniquely positioned to influence a national conversation regarding the integration of social needs into the health care agenda,” Joe said. “The report is a solid roadmap to follow, and we need to continue this momentum.”
The report’s recommendations include the following:
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