SDoH: Service Gaps Apparent Among ACOs

By
Original story posted on: February 12, 2020

  • Product Headline: RESOURCE
  • Product Image: Product Image
  • Product Description:

    The Social Determinants of Health: Case Management's Next Frontier

Industry studies highlight large investments, yet ACOs struggle to integrate SdoH.

Several major research studies have emphasized the large sums being spent by healthcare organizations to better manage the social determinants of health (SDoH), amid ongoing struggles to mitigate service gaps, especially by Accountable Care Organizations (ACOs).

A study published in Health Affairs explored the degree to which U.S. health systems have directly invested in community-based efforts. Researchers scoured public announcements of new programs involving direct financial investments associated with the SDoH by U.S. health systems from the time period of Jan. 1, 2017 to Nov. 30, 2019.

Hefty investments were found across health systems and the five main SDoH domains, encompassing:

  • 78 unique programs involving 57 health systems that included 917 hospitals
  • $2.5 billion of health system funds, of which $1.6 billion in 52 programs was dedicated to housing-focused interventions.
    • Other areas of attention were:
      • 28 employment programs, at investments of $1.1 billion
      • 14 education programs, at $476.4 million
      • 25 food security programs, at $294.2 million
      • 13 social and community context programs, at $253.1 million
      • 6 transportation programs at $32 million

Health systems are clearly making sizable investments in these areas.

The three largest investments were by Kaiser Permanente for $760 million, the Johns Hopkins Health System for $162 million, and MetroHealth in Cleveland for $160 million.

The research excluded programs in which health systems used:

  • Only funds granted by other organizations
  • Programs providing direct medical care, subsidized unfunded care, or funded medical education
  • Those focused only on the healthcare domain, except if providing transportation to enhance health care access
  • Those creating or implementing dedicated screening or referral tools
  • Hospital renovation programs
  • Programs that increased the minimum wage
  • Those involving community investments by financing agencies or insurance payors

 

ACOs Behind the Curve

On another note, data from a recent Dartmouth study shows that despite strong efforts, ACOs continue to struggle integrating social services and medical care. The study pulled qualitative data from 22 ACOs, and used phone calls and site visits, the latter lasting anywhere from 3-5 days. The study also reflected diverse payor populations across the country. While there was high awareness of the importance of addressing the SDoH, the ACOs were way behind the curve:

  • Few had formal programs or contracts in place to address social needs. Those with contracts did not adequately specify target populations. 
  • Few had a clear idea of the social needs of their patients.
  • The quality and availability of community-based organizations (CBOs) has been less than optimal.
  • Only 50 percent are doing a standardized screening of social needs.

Considering the strong value-based care emphasis by ACOs, the data has demonstrated surprisingly low awareness of how care and costs connect for the SDoH populations. With such strong industry attention to the development of cross-sector collaboration, partnerships with CBOs can become a solid way to address the social needs of any community.

Programming Note: Listen to Ellen Fink-Samnick’s live reporting on the State of the Social Determinants weekly on Monitor Mondays, 10-10:30 a.m. EST.

Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP

Ellen Fink-Samnick is an award-winning healthcare industry expert. She is the esteemed author of books, articles, white papers, and knowledge products. A subject matter expert on the Social Determinants of Health, her latest books, The Essential Guide to Interprofessional Ethics for Healthcare Case Management,  Social Determinants of Health: Case Management’s Next Frontier (with Foreword by Dr. Ronald Hirsch), and End of Life Care for Case Management are published through HCPro. She is a panelist on Monitor Mondays, frequent contributor to Talk-Ten-Tuesdays, and member of the Editorial Advisory Boards of Professional Case Management, Case Management Monthly, and RAC Monitor. Ellen also serves as the Lead for Rise Association’s Social Determinants of Health Community.

This email address is being protected from spambots. You need JavaScript enabled to view it.

Related Articles

  • SDoH: Eviction Moratoriums Extended to June 2021
    Loopholes in rental and lease agreements may force individuals and families into crowded living situations. I value when our Monitor Monday and RACmonitor  listeners reach out to me on social media; many did after last week’s broadcast and article on…
  • Kaiser Family Foundation Brief Highlights Ongoing Employment, Poverty Challenges
    More people are expected to struggle with ongoing hardships. There continues to be considerable news focused on ongoing health disparities and inequities. First, the Kaiser Family Foundation recently released a report titled One Year in the Pandemic: Implications of COVID-19…
  • Robert Wood Johnson Foundation Advances Guidance to Address SDoH
    The iconic foundation has published three Federal Policy Recommendations to Advance Health Equity. First, I’d like to follow up on last week’s article about The Gravity Project’s presentation on social risk ICD-10-CM code changes at the March 10 Centers for…