A recent learning collaborative conducted by the Institute for Accountable Care shed light on accountable care organizations’ (ACOs) experiences with targeting social determinants of health (SDoH). Here’s a recap of the biggest takeaways from the participating ACOs.
While data around ACO’s investments in addressing SDoH is limited, efforts have increased over the years. In a recent blog post published by Health Affairs, co-authors Robert Mechanic, a senior fellow at the Heller School of Social Policy and Management at Brandeis University and executive director of the Institute for Accountable Care, and Ashley Fitch, director of community partnerships and innovation at Mount Sinai Health System in New York, looked at the different approaches ACO managers have taken to address SDoH and what’s needed to move the needle forward.
According to their analysis, the four main lessons learned include:
1. SDoH data collection is key
While many ACOs currently screen for SDoH, they lack a systematic approach to identify patients’ social needs and use the data collected. To develop a standardized process, the Centers for Medicare & Medicaid Services (CMS) has instilled several screening policies and in 2023 will add two new measures, including screening for social drivers of health as well as screen positive rate for social drivers of health. Reporting of the measures will be mandatory by 2024, with failure to report subject to payment reductions in 2026.
“ACOs must determine when and how to screen patients,” wrote Mechanic and Fitch. “Multiple screening tools may already be in use across the organization so a process will be required to build consensus around a single screening tool and a uniform method for collecting the data.”
While screening is a critical step, the patient’s comfort and perspective should remain at the forefront of all systems, noted Mechanic and Fitch, allowing patients to decline answering questions as well as providing them with the opportunity to choose how the organization addresses their need.
2. Invest in partnerships with community-based organizations
After screening for SDoH, ACOs must then decide how to responsibly use the information. A comprehensive approach ACOs have found successful includes establishing an inventory of community resources, forging local partnerships with community-based organizations (CBOs), and developing a reliable process for patient referrals to those CBOs.
The partnership is beneficial to both parties, providing ACOs with a trusted resource for “closed-loop” referrals and allowing CBOs an opportunity to participate in payer contracts and potentially earn shared savings payments or reimbursements for services.
3. CBOs need more funding to match support required from health systems
While CBOs are well-positioned to address SDoH, particularly in vulnerable communities, as demand from health care plans and providers increases, the CBOs, which range significantly in size and capabilities, need additional capacity to address patients’ social needs. Substantial funding is required for these organizations to scale their services, explained Mechanic and Fitch.
A promising source of funding recently found to be successful are community care hubs, which support CBOs by facilitating and contracting with payers and health systems, including billing, referral management, data management services, and payer contracts.
4. Government funding can accelerate the integration of health and social services
Demonstrating an immediate return on investment from addressing SDoH remains a challenge for health care organizations. Some have found success by leveraging state resources such as Medicaid 1115 waivers to secure direct payment to address social risk factors among patients as Medicaid can pay for health-related social services.
Similarly, Medicare Advantage plans can also offer non-medical supplemental benefits that could address SDoH, such as home-delivered meals and non-medical transportation.
A look ahead
Policies driving direct investments in community-based services are key to increasing screening of SDoH among ACOs, according to Mechanic and Fitch, who called for additional policy from CMS to encourage such initiatives.
“While advancing health equity is a major focus of the Biden administration, we believe that the policy discussions have not paid sufficient attention to addressing gaps in community social service resources,” they wrote. “Additional federal investment in hubs is needed. CMS should continue working with states to develop Medicaid waivers that include funding for community-based social services providers and consider options to encourage MA plans to invest in these services.”