How Healthcare Organizations Can Help Improve Social Risk Interventions

Financing healthcare organizations’ involvement in social risk interventions would require multiple funding approaches and is not guaranteed to improve the delivery of social services, according to research published in JAMA Health Forum.

Social determinants of health, such as food insecurity, housing instability, and poor transportation access, can lead to significant social risks for individuals. Social risks negatively impact health outcomes, healthcare utilization, and healthcare costs.

Healthcare organizations have tried to help address social risks by working with social services agencies and community-based organizations, known as multisector collaboration. However, the industry tends to assume that healthcare organizations’ involvement in social risk interventions is uniformly beneficial and should be financed by increasing capitated payments for those at greater social risk.

Funding healthcare organizations to participate in social risk interventions could increase intervention costs and detract from other clinical activities, researchers wrote. In addition, the effectiveness of social risk interventions may vary across organizations depending on their capacity, expertise, efficiency, and community relationships.

Involving healthcare organizations in addressing social risk should be considered case-by-case. For example, involvement may be beneficial for interventions closely related to healthcare, such as medically tailored meal interventions that can address comorbidities like diabetes or end-stage kidney disease.

Providing funds for healthcare organizations to deliver social services could require complicated waivers or regulatory changes. This financing could also divert money from community-based social service organizations.

“Although multisector collaborative approaches may be effective for mitigating the consequences of social risks for specific individuals, they typically do not address the underlying social determinants that produce those risks,” the viewpoint stated. “For example, nonemergency medical transportation does not address the income inequality underlying barriers to affordable transportation.”

In situations where involving healthcare organizations in social risk interventions is beneficial, the funding method must support sustainable service delivery and capacity. Multisector collaboration will only work if community-based organizations can maintain the capacity to serve patients referred by healthcare systems.

Providing higher capitated payments to organizations that have patients with greater social risks can help build capacity. However, social risk-adjusted capitated payments may lead to intermediaries misusing the funds or result in healthcare organizations presenting their patients as facing greater risks than they do.

Leveraging a fee-for-service payment model to address social risks could ensure funds are directed toward the intended services but would not support capacity building and could promote the overuse of social services.

Adjusting performance-based payments based on population or individual-level social risk may help avoid targets that penalize organizations with greater social risk. However, this could also eliminate some financial incentives to improve care.

“Because each payment approach has benefits and drawbacks, a mix of financing mechanisms will likely be needed, working in concert toward the overall goal—getting beneficial services to patients with social risks,” researchers wrote.

Healthcare organizations must form meaningful partnerships with community-based organizations for multisector collaboration to succeed. From there, financing approaches must be contextualized in the broader conversation around healthcare’s role in addressing social risks.

“In some cases, improving health for those harmed by social risks may be best pursued entirely outside of the healthcare sector through social policy changes. But in other cases, using healthcare dollars to address social risks to health may be one part of a comprehensive strategy to improve population health and health equity,” the viewpoint concluded.