Integrating Social Services & Health
Co-authored by Austin Frakt and Kate Raphael
The most recent issue of Health Affairs focuses on “Integrating Social Services & Health,” and many of the articles highlight the ways in which social policy is linked to health outcomes. Here are a few that stood out to us.
- Linking Health And Social Services Through Area Agencies On Aging Is Associated With Lower Health Care Use And Spending
Using national survey data from 2008-2013, authors Brewster et al. examined the potential health benefits of partnerships between health care organizations and Area Agencies on Aging (AAA) to address the social needs of older adults. These partnerships include the involvement of AAA with specific health care organizations as well as the involvement of AAA in multisectoral coalitions to promote community health.The authors found that partnerships with hospitals located in an agency’s service county were associated with a reduction of $136 in average annual Medicare spending per beneficiary. Partnerships between AAA and mental health organizations and between AAA and livable community initiatives (coalitions to promote wellbeing/health of older adults) resulted in a reduction in potentially avoidable nursing home use by 0.5 and 1 percentage points, respectively.The authors conclude that investment in these partnerships yields reduced health care use and spending. The authors do not report any overall savings.
A related article included in the April Issue, Integrating Health and Human Services in California’s Whole Person Care Medicaid 1115 Waiver Demonstration, investigates a California model aimed at developing similar partnerships. The authors reported that the pilot program was successful in identifying high-utilizing Medicaid beneficiaries and their engagement with services.
- Embedding Social Workers In Veterans Health Administration Primary Care Teams Reduces Emergency Department Visits
Authors Cornell et al. investigated the impact of an initiative to add social workers to rural primary care teams in the Veterans Health Administration on patients’ use of social work services, hospital admissions, and ED visits. They found that introducing a social worker increased social work encounters by 33% among veterans. Furthermore, among high-risk patients, there was a 4.4% decrease in the number of veterans who had any acute hospital admission and 3.0% decrease in veterans who had an ED visit after introduction of a social worker. This strategy may be an effective method of addressing the social needs of high-risk, high-need populations.
- Housing Intervention For Medically Complex Families Associated With Improved Family Health: Pilot Randomized TrialAuthors Bovell-Ammon et al. conducted a randomized control trial “Housing Prescriptions as Health Care” to investigate the impact on physical and mental health of integrating priority placement in affordable housing and the provision of services compared to standard of care.In the period from 2016-19, 78 homeless/housing-unstable families in the Boston area identified as “medically complex” were enrolled in the trial. The authors conducted a difference-in-difference analysis at six months into the trial and found that the intervention caused a decrease in poor health in children and a decrease in anxiety and depression among parents. Bovell-Ammon et al. concluded that a population-specific model that integrates health, housing, legal, and social services has great potential to improve health outcomes at the household level.A related analysis on housing models in the New York City area—The Development of Health and Housing Consortia in New York City—was also included in the April issue. The authors describe the formation of a health and housing consortium in the Bronx and the replication of that model in Brooklyn.
- Cash Benchmarking For Integrated Health Care And Human Services Interventions: Finding The Value AddedAuthors Berkowitz, Edwards, and Polsky proposed an innovative methodological approach of cash benchmarking as a means of evaluating when the integration of human services addressing health-related social needs into health care is most useful. Cash benchmarking is a study design that comes from the field of developmental economics where one group receives an intervention and another group receives the monetary value of the intervention in the form of cash. This design is particularly helpful for evaluating interventions concerning health-related social needs because that type of intervention often aims to address issues that stem from a lack of financial resources; therefore, observing a benefit from an intervention in a cash-benchmarked study means that the intervention provides benefits greater than what can simply be conferred through a cash transfer. The authors put forth this design as a method of evaluating interventions in a more actionable way and providing policymakers with the tools to make informed, evidence-based decisions.
- There were many other papers of potential interest including:
- Buying Health for North Carolinians: Addressing Nonmedical Drivers of Health at Scale, which describes four initiatives implemented by the North Carolina DHHS in an attempt to integrate medical and nonmedical drivers of health;
- Innovative Integrated Health and Social Care Programs in Eleven High-Income Countries, which inventories 30 health care programs in 11 high-income countries using structured surveys to identify common features in implementation of innovations;
- and Innovative Policy Supports for Integrated Health and Social Care Programs in High-Income Countries, which surveys integrated health and social care programs in high-income countries and recommends a hybrid top-down/bottom-up approach to support integrated care.