Addressing Social Factors in the healthcare Safety Net
Spurred on by reforms included in the Affordable Care Act and other national trends, California is fundamentally transforming how it pays for the care of patients in Medi-Cal, its state Medicaid program. Rather than maximizing the volume of care delivered, regardless of outcome, Medi-Cal payers and providers must now optimize value, which couples improved health with manageable costs.
Driven by this shift, health plans and delivery systems are paying greater attention than ever to the factors beyond healthcare — like community, safety, education, and family stability — that influence a person’s health. If health outcomes are to improve, Medi-Cal providers and health plans must to be able to understand the comprehensive needs and circumstances of their patients, and learn to coordinate with complex support systems to make sure those needs are met.
The safety net is an ideal market for innovative, collaborative solutions that empower providers to understand their patients’ medical and social needs. Given their growing understanding of the cost-effectiveness of prevention and their drive to contain costs, commercial markets may soon seek such solutions, too.
Overview of article
- Researchers outline the business case for health systems, clinics and health centers, and payers for meeting human needs. Specifically, health systems should address social determinants of health (SDOH) to avoid unnecessary procedures, emergency department (ED) visits, and hospital admissions, save staff time, and enhance patient experience. Clinics and health centers should address SDOH because it optimizes use of limited resources (e.g., staff time), maximizes time spent on clinical and behavioral conditions, and develops whole-person care in anticipation of future APMs. Plans should address SDOH to lower total cost of care (TCOC), improve outcomes, and improve member satisfaction on the Healthcare Effectiveness Data and Information Set (HEDIS_
- The report outlines capabilities needed to address SDOH, including access to data on social needs and circumstances, the ability to analyze data and facilitate community linkages, and established community channels between healthcare facilities and referral agencies
- Finally, the report highlights key principles for the successful design and implementation of technology to address SDOH, including optimal fit with patients and providers, able to link to EHR systems and be used to exchange data electronically, produce actionable and accessible data, be able to be tailored to a variety of safety net settings, and affordable to resource-constrained safety-net customers