Health care is a term often associated with doctors, hospitals, and medical treatments. Indeed, dictionary definitions of the term often invoke medical interventions as examples of health care services. Yet the importance of social factors in the health of an individual or community can no longer be ignored. We, therefore, offer a clarified definition of health care to include the sum of three categories of service providers:
- Medical Care Services (care management, physicians, hospitals, etc.)
- Behavioral Health Care Services (psychologists, social workers, substance use treatment providers, etc.)
- Social Care Services (housing providers, food assistance providers, transportation assistance providers, etc.)
The evolving health landscape
Social care providers, sometimes referred to as community-based organizations, are on the cusp of a disruptive change in the way they can operate financially. The old system of attaining funding by requesting grant money from the government or private foundations is rapidly being replaced by a move to receiving funding from health insurance companies and at-risk care delivery organizations who offer financial incentives—such as shared savings—for their part in keeping individuals healthier while reducing the total cost of care.
This is all part of a shift in the focus of health care overall. In the past, medical care providers were paid based on fee-for-service (FFS) arrangements. As such, the services they delivered were completely independent of services delivered by social care providers.
Today, health care payment policies are moving toward value-based models, where provider reimbursement from health insurance companies is based on improved health outcomes rather than volume of services provided. The healthier they keep their patients—and the more they can prevent them from needing the hospital or emergency department—the more money they make. Needless to say, this is a 180-degree turnaround, and it hasn’t been painless. Since reimbursement is tied to health outcomes, the spotlight is shining brighter on the social care providers to which they refer their patients.
Related article: How Technology is Addressing SDOH
Medical care providers can no longer simply refer an individual to a social care provider and consider their part finished. Both sides need to work together to track referrals and report on outcomes, preferably as part of an organized network, so they can both reap the rewards of the risk-based contracts. Some examples of states, managed care organizations (MCOs), and social care providers that already have programs under way include:
- Arizona, which requires coordination of community resources such as housing and utility assistance under its managed long-term services and supports contract.
- The District of Columbia, which encourages MCOs to refer beneficiaries with three or more chronic conditions to the “My Health GPS” Home Health program.
- Louisiana, where plans are required to screen for problem gaming and tobacco use, and referrals to the Special Supplemental Nutrition Program for Women, Infants, and Children are required.
- Nebraska, which requires MCOs to have staff trained on social determinants of health (SDoH) and to be familiar with community resources.
- North Carolina, which has established NCCARE360, a state-wide closed-loop referral network between social care providers, MCOs, and medical care providers.
Health payers have also taken an active interest in this new, integrated approach as evidenced by the announcement that Kaiser Permanente has launched a program to equip all of the providers in its network with technology tools to address SDoH. Working with Unite Us, a health IT network that links social care organizations with medical providers, Kaiser Permanente is looking to create a seamless electronic platform for supporting connections between organizations. This concept was pioneered by Unite Us in partnership with Alliance for Better Health, which was a significant contributor to its SDoH model.