National Academy of Medicine advocates partnerships, expanding definition of ‘health’ to advance SDoH
This week, a report from the National Academies of Sciences, Engineering, and Medicine (NAM) stumped for continued work to advance the integration of the social determinants of health with the medical industry. The report’s authors identified barriers to the integration and outlined recommendations to address these barriers.
Specifically, the authors targeted three necessities for a successful integration:
- An appropriately trained workforce;
- Health IT innovation; and
- New financing models
Members of the committee that authored the report — which includes Karen DeSalvo, professor of medicine and population health at the University of Texas and former national coordinator for health IT — noted on a webinar that while health and health equity are at the core of their recommendations, their suggestions should be set against the backdrop of the current healthcare landscape.
The U.S. has invested a lot of money into healthcare and, oftentimes, that investment falls short on outcomes, they noted on the webinar. Given the importance that social factors play into health, addressing social needs is going to be critical moving forward, the speakers added.
Ultimately, the report recommended the following steps:
- Better integrate social care into healthcare delivery;
- Support and train an engaged, integrated workforce;
- Develop an infrastructure for data sharing between health and social care;
- Finance the integration of healthcare and social care.
Yet, the committee noted that social integration can’t happen in a vacuum of the medical community. For this reason, the committee wanted to set a theme of teamwork, stressing multi-sector collaboration and partnerships.
The point isn’t to medicalize social factors, but to strengthen partnerships with action in mind, DeSalvo stated on the webinar.
The NAM report echoes a pair of studies recently released from JAMA and Urban Institute — which found low levels of social screening in doctor’s visits and insurers adding social supplemental benefits, respectively — in that it shines a light on how new this space is and will be for both the medical healthcare and social care communities.
A consistent topic on the limitations of integration involve financing and reimbursement for social services in a medical setting.
For example, in the Urban Institute report, one major barrier from adding supplemental benefits addressing social factors to Medicare Advantage plans was the lack of funding associated with benefits expansion. Still, Chris Esguerra, senior medical director at Blue Shield of California, pushed for more commercial payers to expand benefits during the webinar call.
“Your payer status doesn’t absolve you from having a social event in your life,” Esguerra said.
The NAM committee acknowledged the reimbursement challenge to integrating social care with healthcare communities. The committee advocated for expanding the definition of what activities are considered healthcare services and investigating how social care services can be paid for under new definitions.
“We hope that [definitions] will change with value-based [care] but until then we should look at who we’re calling healthcare professionals,” Robyn Golden, professor at the department of health systems management at Rush University Medical Center, said on the webinar. “People don’t live in hospitals, they live in communities.”
Specifically, the report recommended 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 healthcare and social care service providers;
- Incentivize healthcare organizations and the managed care programs that contract with Medicaid and Medicare to collaborate with community-based social services; and
- Coordinate the coverage and benefits of dually eligible and high-need Medicare and Medicaid populations.
Last year, Town Hall Ventures founder Andy Slavitt stated at HLTH, “I encourage people to … come up with ideas how to solve [social determinants of health]. To turn them into models before we understand them kind of scares me.”
With new calls for partnerships, continued consumerization of healthcare, and the need to prove a financial ROI for social efforts, expect more experimentation and research in the space as the industry assesses its effectiveness.
But don’t expect the evidence to materialize overnight. Researching the effectiveness of social programs in medical settings will take years to properly assess. Until more research is published, healthcare and social care organizations will have to act on the good faith that the work is important to take on, if they choose to integrate and partner among each other.
