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ACOs are struggling to integrate social services with medical care, findings show

Little progress is being made to integrate social services with medical care despite increased attention and effort.

Jeff Lagasse, Associate Editor

Tackling social determinants of health -- the social and socioeconomic factors that influence a person's care, such as income and access to transportation -- is generally considered a means by which the healthcare industry can curb spending. But this appears to be one area in which Accountable Care Organizations are struggling.

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 ACOs -- which receive financial incentives for meeting quality and cost-reduction targets -- have been considered among the most likely to pursue integration.

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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. They were frequently "flying blind," lacking data on their patients' needs and on the capabilities of potential community partners.

Plus, 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 help in the integration of social determinants, according to the authors, include providing sustainable funding, facilitating partnership development via local and regional networking initiatives, and "developing standardized data on community-based organizations' services and quality to aid providers that seek partners."


The rise in illnesses caused by peoples' behaviours and the social determinants of health threatens to suffocate budgets in both wealthy and poor countries, while suppressing the power of modern medicine to improve lives, found a PricewaterhouseCoopers report in September.

The trends in SDOH are intersecting with trends in artificial intelligence. Factoring in SDOH is possible due to data, and if AI shines in any one particular area, it's making sense of complex data sets.

If the social determinants are comprised of the socioeconomic factors that can influence a person's health -- income, education, access to transportation, etc. -- then AI has the potential to allow providers to make the best possible use of that information.

That becomes increasingly important as value-based care emerges. With reimbursement increasingly tied to health outcomes, providers have a real incentive to ensure they're delivering the best care possible.

Twitter: @JELagasse

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