Clinics Working to Address Social Determinants of Health, Study Finds

A growing number of healthcare providers are investing in efforts to address not only the clinical needs of their patients but also the unmet social needs that affect their health, a report from , the , the , and the finds.

According to the report, (36 pages, PDF), research has shown that social and economic factors such as income, educational attainment, employment status, and access to adequate food and housing directly affect health and longevity, especially for lower-income populations. Several of the conditions that account for the highest healthcare expenditures — including heart disease, mental disorders, asthma, diabetes, hypertension, and hyperlipidemia — are linked to unmet social needs, while unemployment and poverty have been linked to a higher risk of hospital readmission for heart failure and pneumonia.

With the Affordable Care Act expanding insurance coverage for low-income individuals and the healthcare system under pressure to achieve the "triple aim" of improved health, improved care, and lower per-capita cost of care, providers are beginning to incorporate social supports and interventions into their clinical care models. Strategies used by primary care clinics to link patients to local resources include clinicians identifying patients' unmet social needs and writing a "prescription" to be filled by staff, who then connect the patients with services, and placing lawyers and paralegals in clinics to help patients address legal issues that affect their health. Targeted interventions mentioned in the report include the Seattle-King County Healthy Homes Project, in which community health workers conducted home visits and provided self-management and social support services to low-income families with children with uncontrolled asthma, reducing the share of children using urgent care services by two-thirds and lowering urgent care costs by as much as $334 per child.

The report's authors note that in addition to the ACA's provisions for improving patient and community health, "community benefit" spending by nonprofit hospitals could help pay for such interventions. "As more low-income people gain health care coverage, evidence on which interventions are most cost-effective in addressing their social needs and improving their health will grow, and value-based reimbursement will become standard across payers," they write. "With these changes in the health care landscape, the economic case for provider investment in social interventions will become ever more compelling."

"." Skoll Foundation Press Release 06/04/2014. "." Commonwealth Fund, Skoll Foundation, and Pershing Square Foundation Report 06/03/2014.