A new report from the National Academies of Sciences, Engineering, and Medicine offers several recommendations about better integrating patients’ social needs into healthcare delivery. Among other things, the report calls for a national vision and defined technology standards for integrating healthcare and social care data.
Titled “Integrating Social Care Into the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health,” the report notes that two trends are driving a need to integrate social care with healthcare: the move to pay providers based on health outcomes, rather than for individual visits or services; and an increasing recognition that addressing non-medical factors such as housing, education, neighborhood safety and employment — has a profound impact on one’s physical and mental health. “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 Kirsten Bibbins-Domingo, M.D., P.H.D., a general internist and vice dean for population health and health equity at the University of California, San Francisco, and chair of the committee that wrote the report, in a prepared statement. “Integrating social care into healthcare delivery can be transformative for addressing the individual needs of patients and the collective needs of communities. However, we need the workforce, financing and infrastructure to do this effectively.”
The report recommends the following steps:
Better integrate social care into healthcare delivery. In order to implement social care more systematically throughout the U.S., healthcare 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 healthcare teams
- Establish more formal linkages, communication, and financial referral relationships between the healthcare and social care sectors
Support and train an engaged, integrated care workforce. 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 healthcare, 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 healthcare 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 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, such as Area Agencies on Aging
- Coordinate the coverage and benefits of dually eligible and high-need Medicare and Medicaid populations
The report also notes that there have been few formal evaluations of the effectiveness of integrating social care needs into healthcare delivery. Federal and state agencies, foundations, and other funders of research should support timely, robust evaluations that help inform policy, the researchers said. 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 healthcare.
The study upon which the report was based was undertaken by the Committee on Integrating Social Needs Care into the Delivery of Health Care to Improve the Nation’s Health.
It was sponsored by the Archstone Foundation; the Association of Oncology Social Work; Bader Philanthropies; Chicago Community Trust; Community Memorial Foundation; the Council on Social Work Education; Episcopal Health Foundation; Health Foundation of Western and Central New York; Healthy Communities Foundation; the Helen Rehr Center for Social Work Practice; Josiah Macy Jr. Foundation; Kaiser Permanente National Community Benefit; the National Association of Social Workers and the NASW Foundation; New York Community Trust; Robert Wood Johnson Foundation; SCAN Foundation; and the Society for Social Work Leadership in Health Care.
