The federal government has announced a $157 million project to help hospitals and doctors link Medicare and Medicaid patients to needed social services that sometimes have a bigger effect on their health than medical interventions.
Public health experts have known for decades that even with medical care easily available, patients are often limited in their ability to get better or maintain good health if they lack stable housing, access to healthy food, or the ability to get to and from medical appointments.
The goal of the Accountable Health Communities project is to find better ways to identify patients’ non-medical needs and connect them to available services in their communities. The social services to be linked include those related to housing, food, personal safety, inability to pay utility bills and transportation. The project will fund up to 44 separate experiments over five years. Applications are being accepted by the Centers for Medicare and Medicaid Services, and announcement of the winning proposals is expected later this year.
The goal of combining medical and social services is not just to help patients, wrote the team in charge of the project in this week’s New England Journal of Medicine. “The test will assess whether systematically identifying and addressing health-related social needs can reduce health care costs and utilization.”
“Many community service organizations … might be able to help” patients with health-related social needs, said Dr. Patrick Conway, chief medical officer at CMS in a conference call with reporters. “But many clinics and hospitals aren’t linked well to these organizations.”
There are already small-scale examples of one-stop shopping for medical and social needs across the country that are showing positive results. For example, Hennepin Health in Minnesota, which serves low-income residents who are eligible for Medicaid, has reduced both hospital and emergency room admissions in its caseload.
The bigger challenge is “scaling up” — or figuring out how to provide such services to more people who need them.
Part of the problem is a cultural gap — not between the patients and providers, but between health care professionals and social service agencies.
Medical and social service providers “are not used to working with one another or collaborating,” said Tricia McGinnis, a vice president at the Center for Health Care Strategies, which works on projects to improve state Medicaid programs.
And more often than not, the bureaucracy involved — particularly in programs that serve the poor — can make collaboration difficult if not impossible.
For example, said CHCS Vice President Allison Hamblin, “fitting together a complicated Medicaid financing stream with a complicated housing financing scheme — it’s horrendous.”
McGinnis said that projects to connect health and social services are getting more popular as the health care moves toward a payment system that rewards medical providers for keeping patients healthy rather than simply doing things to them. Such systems provide a financial incentive to make sure social needs are met, if only to keep down their medical bills. But it’s not clear how fast those savings might materialize.
For the sickest and most expensive patients, things like helping them get to and from medical appointments and helping pay utility bills so they don’t have to choose between that and buying medication can produce savings “probably pretty fast,” she said. But for patients whose social service needs are purely preventive, “it’s hard to reap those (medical) savings quickly enough” to reimburse the social service providers.
Perhaps most critical to the program, said Ashish Jha, a professor at the Harvard School of Public Health, is that the 44 separate programs about to be funded be rigorously evaluated “so we actually learn what works and what doesn’t.”
The program is being run by the Center for Medicare and Medicaid Innovation, which was created by the Affordable Care Act to find ways to improve and pay for health care. But its record so far on providing results of its projects has been spotty at best.
“The innovation center hasn’t been the strongest” at evaluation, Jha said.