Patients who can’t buy food are not going to buy medications. Patients who don’t drive or have a car often can’t get to doctor’s appointments. Mental health problems can cause a host of issues when it comes to adhering to a care plan. These are just some of the nonmedical issues facing patients, and they keep patients from achieving the improved health outcomes that providers need them to reach to secure reimbursements and avoid penalties.
Melinda K. Abrams, vice president of delivery system reform for The Commonwealth Fund, says the literature linking social and economic factors to health outcomes is clear.
“These studies uniformly suggest that nonmedical factors play a substantial role, in fact a larger role, than other aspects of healthcare,” Abrams says. “When we really examine the needs of patients with clinically complex needs, a lot of what contributes to that complexity is not just their medical conditions, but their social health conditions and needs.”
New connections needed
Karin VanZant, executive director of life sciences at CareSource managed care company, started her career as a social worker and community developer. “I look at these issues through a completely difference lens,” says VanZant. “Constantly, I’m looking at my colleagues with MDs and PhDs wondering how they think people can be compliant when they don’t have resources.”
At CareSource, she’s working on a care model that values social stability in a way that historically has been reserved for physical health. This includes making sure an individual has stable housing, education and training, and support structures. The organization is exploring ties with housing and education groups, chambers of commerce and others to develop more community support.
“We’re starting to prove there’s lots of resources that our members are taking advantage of and there are a lot of resources they aren’t taking advantage of because they didn’t know they existed,” VanZant says.
In some cases, patients have a medical diagnosis compounded by mental health problems and social factors. The question, VanZant says, is how to best identify these issues and triage that patient. Many times, however, this process stalls in the physician’s office.
“I think the hesitancy, especially when we talk to health partners, is how to make that connection. The reason that sometimes the questions aren’t being asked around behavioral health and social stability is that many clinicians have been trained not to ask a question they don’t have the answer for.”
In one internal study, CareSource found that assigning Medicaid members life coaches to address social factors reduced emergency department utilization and hospital stays and improved compliance.