On January 5, 2016, the Department of Health and Human Services announced $157 million in funding to address the health-related social needs of Medicare beneficiaries and associated referrals to and navigation of community-based services. Called the Accountable Health Communities Model, it is a 5-year program and the first CMS Innovation Center model to focus on health-related social needs of Medicare and Medicaid beneficiaries. For a health care system that has historically focused on funding care that occurs in a clinic, hospital, or nursing facility, this is a significant advancement. It is a novel approach for testing whether screening patients for health-related social needs and connecting them to local community based organizations focused on housing, food security, and transportation, will ultimately improve their health and lower health care system costs.
Our country desperately needs a model such as this as it is estimated that more than 95% of the $3 trillion spent on health care in the U.S. each year funds direct medical services, even though 60% of preventable deaths are rooted in modifiable behaviors and exposures that occur in the community. In fact, in other developed countries, for every $1 spent on health care, about $2 is spent on social services. However, in the U.S., for $1 spent on health care, about 55 cents is spent on social services. This is the lowest ratio among all developed countries.
Therapists in skilled nursing facilities feel this spending disparity all too well. Take the older adult with diabetes preparing to return home who is forced to choose between paying for heat and buying groceries. In our current system, patients’ health-related social needs often go unaddressed. As therapists, we commonly uncover these desperate social needs in our evaluation and subsequent encounters with the patient and their family members. However, our health care system lacks the infrastructure and incentives to connect systematically the array of community-based service providers that would be required to address patients’ health-related social needs. As a result, despite our best therapeutic interventions while they are with us, many patients often return home only to fail and return to the hospital due to unaddressed social needs.
Innovative payment models, such as bundled payment and value-based purchasing, are driving the redesign of how we deliver care in hospitals and nursing homes and eventually rehab. However, until we address the social determinants of health outcomes and collaborate with other community stakeholders, I am afraid we will find ourselves coming up short of our goals of health promotion. We need to view ourselves accountable for the health and health care of our communities to achieve true health care reform.
I would love to hear what you think!
Mike Billings, PT, MS, CEEAA – President
Alley, D.E., Asomugha, C.N., Conway, P.H., & Sanghavi, D.M. (2016). Accountable health communities: Addressing social needs through Medicare and Medicaid. The New England Journal of Medicine, 374(1), 8-11.
Bradley, E.H., & Taylor, L.A. (2013). The American health care paradox: Why spending more is getting us less. New York, NY: Public Affairs.
HHS.gov (2016, January 5). First-ever CMS Innovation Center pilot project to test improving patients’ health by addressing their social needs. Retrieved from https://www.hhs.gov/about/news/2016/01/05/first-ever-cms-innovation-center-pilot-project-test-improving-patients-health.html#