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by mmiliard on Wed, 2019-09-25 14:27
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.
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.
WHY IT MATTERS
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 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.
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 LARGER TREND
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 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.
ON THE RECORD
"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.
"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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