Mount Sinai Launches Data-Driven Medical-Legal Program to Address Patient Needs

Mount Sinai Health System has launched a medical-legal program aimed at improving health outcomes and equity for patients in underserved communities by proactively intervening to address health-harming legal needs.

Social determinants of health (SDOH) have a major impact on population health outcomes and health equity, leading to increased interest in SDOH interventions across the healthcare industry in recent years. However, many SDOH factors are difficult to tackle because they are influenced by structural or economic components outside healthcare facilities.

Legal needs that can harm a person's health fall under this hard-to-tackle SDOH category because they are both medical and legal. Many providers do not have the capacity to address health-harming legal needs as a result, and as a result, some health systems, like Mount Sinai, have turned to medical-legal partnerships (MLPs). These are defined by the Health Resources & Services Administration’s National Center for Medical-Legal Partnership as “[partnerships] in which lawyers and paralegals work alongside health care teams to detect, address and prevent health-harming social conditions for people & communities.”

As part of Mount Sinai’s MLP, the health system is collaborating with the New York Legal Assistance Group (NYLAG)’s LegalHealth Division and payer organization Healthfirst to provide a program that proactively identifies patients with unaddressed legal needs and provides free, civil legal services to address them to improve health outcomes.

Data is a major driver of any medical-legal program’s success, making efficient data collection and use crucial. Mount Sinai’s program is integrated into EHR workflows and utilizes both clinician referrals to the program and data analytics to identify patients who may face health-harming legal needs. Patients are identified using categories of legal risk, including income maximization, immigration and naturalization, housing, and personal safety.

Once at-risk patients are identified, Mount Sinai care managers conduct legal needs screenings and obtain consent from the patients to refer them for an initial consultation with LegalHealth. Following the consultation, patients may be eligible to receive free legal services based on the legal issues involved in their case.

"Legal issues should never stand in the way of health. This program’s innovative approach is data-driven, collaborative, and preventative, aligning with the standard of care patients need to access legal services that can change the trajectory of their health and their lives,” said Randye Retkin, director of LegalHealth, in the press release.

Mount Sinai evaluated the program’s potential during a recent 12-month pilot. The program’s analytics tools identified 1,959 patients with a potential unaddressed legal need. These patients were subsequently screened and given referrals if needed.

Overall, 165 referrals were provided, and 157 patients consented to legal assistance. Several patients had multiple unmet needs, resulting in 264 distinct legal matters being handled. Of these, 211 were resolved. The most common legal issues patients had related to housing and income maintenance.

“These results not only demonstrate the need for innovative, sustainable programs that accurately identify social and legal needs and strengthen integration across healthcare organizations, but also… highlight the potential to scale and replicate this program to have a significant, positive impact on health equity for vulnerable patients and their communities, and to become programmatic through aligned value-based care,” said Robert Fields, MD, Mount Sinai's chief population health officer, in the press release.