New findings from a Dartmouth-led study, published in the February issue of Health Affairs, show that despite effort and attention on the part of some healthcare providers to better address their patients' social needs--such as transportation, housing, and food--little progress is being made to integrate social services with medical care.
Given the substantial impact of social factors on health outcomes and medical costs, healthcare providers who join Accountable Care Organizations (ACO)--who receive financial incentives for meeting quality and cost-reduction targets--have been considered among the most likely to pursue integration.
To understand how a highly motivated and committed group of such providers has fared at addressing their patients' social needs, the researchers collected qualitative data from 22 ACOs across the U.S. from 2015-18. As early adopters, the group was actively working on initiatives to address social determinants of health.
However, even these ACOs faced substantial challenges in integrating social services with patient care. "First, we found that the ACOs were frequently 'flying blind,' lacking data on both their patients' needs and the capabilities of potential community partners," explains first author Genevra Murray, PhD, a research scientist at The Dartmouth Institute for Health Policy and Clinical Practice, who collaborated with colleagues from the University of California Berkeley and the University of North Carolina at Chapel Hill on the study.
In addition, partnerships between ACOs and community-based organizations, while critical, were only in the beginning stages of development. And, innovation was constrained by ACOs' difficulties in determining how best to approach return on investments in social services, given shorter funding cycles and more lengthy time horizons to see results.
"Policies that could facilitate the integration of social determinants include providing sustainable funding, implementing local and regional networking initiatives to facilitate partnership development, and developing standardized data on community-based organizations' services and quality to aid providers that seek partners," says Murray.
The Dartmouth Institute for Health Policy and Clinical Practice is a world leader in studying and advancing models for disruptive change in healthcare delivery. The work of Dartmouth Institute faculty and researchers includes developing the concept of shared decision-making between patients and healthcare professionals, creating the model for Accountable Care Organizations (ACOs), and introducing the game-changing concept that more healthcare is not necessarily better care.