Should Accountable Care Organizations Include Social Services?

January 30, 2017 - While government agencies, healthcare payers, and medical organizations put their efforts and hopes in advancing accountable care organizations (ACOs), these healthcare delivery reforms lack significant social service interventions, according to a new report from Health Affairs.

Investing in social services tend to add value to the quality of accountable care organizations. However, many ACOs under state Medicaid programs and the Centers for Medicare & Medicaid Services (CMS) tend to lack payment incentives to integrate social services.

Social and community factors play a role in driving patient wellness but current ACOs tend to have a focus mostly on standard healthcare services. In order to gain greater benefits from accountable care organizations, stakeholders should partner with social services organizations and create financial reforms.

The Commonwealth Care Alliance (CCA) is one example of an accountable care organization that adheres to managing physical and behavioral health along with meeting social needs. The ACO works with community organizations and integrates social services alongside behavioral health and medical care.

The CCA covers 19,000 beneficiaries who have both Medicare and Medicaid coverage. Many of these patients are elderly or disabled while others are low-income and some are homeless. Approximately 80 percent of these beneficiaries have both a mental health disorder along with physical ailments. As such, these patients are in need of social services to support their wellness.

“Reflecting these realities, the fully integrated, person-centered view of a true Social ACO, including direct investment in population-wide interventions that can be adapted to meet the needs of each individual consumer, produces tangible clinical and financial benefits,” the report stated.

“When we look across the landscape of ACOs … we see little cause for optimism that these trends are taking hold. Instead, integration of social factors in most delivery systems is an afterthought — comprising, at best, a patchwork quilt of connections to disparate social agencies that may or may not be optimally positioned to meet an individual patient or family’s needs.”

The report from Health Affairs urges payers and providers to expand the integration of social needs in order to improve health outcomes for patients with some of the most complex conditions.

The report authors explain the method for creating an accountable care organization focused on expanding social services. Care coordination, primary care integration, and patient-centered reforms will be a necessity.

Health insurance companies could put funds from monthly premiums into social services, behavioral health, and other medical spending. One example is using these dollars to pay for clinically-based meals for diabetes patients as well as for their insulin to manage their symptoms and improve their health.

Patient engagement and creating a comprehensive care plan will be imperative when creating a stronger accountable care organization. Payers could ensure that any social needs are recorded in a patient’s comprehensive care plan during the first weeks they enroll in a health plan.

The report authors also advise payers to adopt global capitation to finance medical, behavioral health, and social needs. Any savings garnered through a reduction in acute care utilization could be put toward investing in social services and primary care practices.

Accountable care organizations and healthcare payers looking to reduce medical spending as well as improve health outcomes should consider integrating social services, according to findings from Leavitt Partners and the Robert Wood Johnson Foundation.

“Research has shown a positive relationship between spending on social services and improved health. As researchers, policy makers, and the general public begin to better recognize the many factors influencing individual and population health beyond direct clinical care, some localities, states, federal agencies, and research organizations have shown interest and engaged in efforts to measure total investments being made to produce health,” according to the Robert Wood Johnson Foundation report.

Looking outside of the standard brick-and-mortar clinical facility for improving patient wellness could play a large role in strengthening accountable care organizations and healthcare delivery. Some potential solutions could be payers working with food banks or housing resources to assist the most needy patients.

By incorporating social services in the operation of accountable care organizations, payers and providers could reduce medical spending as well as improve overall health outcomes among their patient community.