My first job after graduating college was as a reporter for a newspaper in a rural Arkansas town. A few months into my tenure, the editor graciously but perhaps unwisely offered me the opportunity to write a weekly column, and it was not long before I was getting occasional reader kudos ― but more often scorn for some of my enthusiastic but admittedly muddled opinions.
One of my least popular columns focused on a now-defunct entertainment retail chain that was the town’s main source for the purchase of books and music and the rental of movies and video games. The store had drawn my ire for its consistent deficit in portfolio across all of its entertainment products. What the small but bustling college town needed, I argued, was a broader selection, and the retail chain should focus on doing at least one thing well rather than being subpar in all of the things.
It was a harsh assessment. Unfortunately, the retail chain’s fatal flaw was one that often follows when businesses take on a product or service line because there is a demand in the market for it but they don’t quite have the aptitude to execute well. As a result, the services or products at which they may have historically been proficient end up deteriorating.
I fear this very scenario for health care providers, who are increasingly screening for and attempting to address social needs such as lack of food and housing in addition to treating patients’ physical and mental conditions.
Why are health care providers taking on this additional activity? Extensive evidence shows that unmet social needs impact the health, wellness, and longevity of patients, particularly lower-income communities and communities of color. For example, asthma has been associated with poor living conditions, and diabetes-related hospital admissions have been linked with food insecurity.
The critical impact of unmet social needs on health outcomes is not new to health care providers, but most providers have been ill-equipped to address these needs. Social services are generally not the types of services offered within the clinic walls and are often provided by a patchwork of community-based organizations with a distinct network separate from that of health care providers.
Some health care providers have avoided screening for social needs for several reasons. Well-vetted screening tools that could be administered so as not to disrupt the patient flow have been hard to find. Within the last few years, however, the American Academy of Family Physicians and other health professional organizations have developed and validated screening tools and guidance for providers to quickly and efficiently screen patients.
Even with these tools, though, some providers have been reluctant to screen because they are challenged with the ability to link patients with community-based resources. Perhaps the biggest reason has been the absence of a financial incentive. Health care providers are paid for providing medical services, not social services.
The financial landscape is changing with the movement toward value-based payment models that reward health care providers based on health outcomes rather than processes and volume of services. This change has incentivized health care providers to invest in data collection including screening and interventions to address patients’ social needs. It has also stimulated the development of electronic platforms for screening and referral to community-based services, including feedback for health care providers on delivery of services and case resolution. Economists have begun to examine collaborative approaches to financing social need interventions so that health care stakeholders can realize a return on and sustain their investments.
I know I am not alone in having serious reservations about funneling insufficient funds to address unmet social needs through a medical industrial complex that already struggles to provide sufficient access to care, achieve quality health outcomes, and control costs. A more direct and adequate investment in community-based social services would be ideal but more politically challenging.
I am optimistic that health care providers can juggle this extra ball. After all, most health care providers have informally been on the watch for patients’ unmet social needs their entire careers. Now they will have financial incentives and, hopefully, the tools to ensure that social services are seamlessly delivered to the people who need them most.
Editor’s note: Craig Wilson, JD, MPA, is the director of health policy for the Arkansas Center for Health Improvement, an independent, nonpartisan health policy center in Little Rock. The opinions expressed are those of the author.