Investing in Interventions That Address Non-Medical, Health-Related Social Needs

Marie-Martinez R, Alper J
Source: National Academies Press
Publication Year: 2019
Patient Need Addressed: Food insecurity, Homelessness/housing
Type of Literature: Grey


Insights Results

Overview of article

  • This article is a proceeding from a workshop that explored non-medical health-related social needs and implications for multiple stakeholders in this area
  • The objectives of the workshop were to 1) Explore effective practices and the supporting evidence base for addressing the nonmedical health-related social needs of individuals, such as housing and food insecurities; 2) Review assessments of return on investment (ROI) for payers, health systems, and communities; and 3) Identify gaps and opportunities for research and steps that could help to further the understanding of the ROI on addressing nonmedical health-related social needs

Key takeaways/implications

  • Non-medical, health-related social needs and social determinants of health have 2 different, but complementary meanings, respectively requiring their own approaches. On-medical, health-related social needs require midstream solutions that identify and help address the social and economic needs of patients (e.g., finding stable housing), while social determinants of health require upstream solutions that change the law or implement policy that affects an entire community (e.g., increasing affordable housing)
  • Addressing social determinants of health also requires addressing root cause and roots of social justice
  • Key interventions noted in the discussion are threefold: 1) Housing; 2) Addressing food insecurity; and 3) Addressing multiple social needs
  • Investments in interventions that address the social determinants of health not only improve health but can be cost effective and cost saving. However, there are many economic impediments to investing in such interventions
  • There is little research on ROI for prevention interventions. There are also non-financial forms of ROI and other drivers of provider behavior in a value-based environment including, alignment with organization’s mission. Additionally, it is challenging to evaluate and scale ROI Another challenge in ROI is scaling and evaluating the ROI at broader level. The definition of ROI may need to be refined to deemphasize its financial focus
  • Research gaps identified in the workshop include: 1) Understanding how to best identify needs and the patients who can benefit from types of interventions available in the healthcare sector; 2) Patient acceptability of healthcare based social risk screening; 3) Feasibility and sustainability of data collection; 4) Impact of incentives on policy and payment models; 5) Adjustment activities (e.g., individualization of care); and 6) Evaluation of the effect of interventions on health. utilization and costs. There is also a need for a systematic assessment of the extent and nature of unmet health-related social needs at a population level for different subgroups in Medicaid and Medicare. Moreover, there is a need to better understand tradeoffs that payers face in designation of specific services under their plans that can be covered and reimbursed v. letting plans decide how to use a flexible pot of money to meet needs they observe in their clients
  • Ways to help identify gaps in knowledge include development, validation and standardization of tools that measure SDOH and social needs, shift towards longitudinal research, integration of other data sources that could provide useful information, and involvement of more experts and stakeholders outside of the healthcare sector