To say it is a pivotal time for health care in the United States is no overstatement. An emphasis on the triple aim of improving population health and quality of care while reducing health care costs is bringing about a paradigm shift in health care and public health spheres. To meet this demand, it is becoming more widely recognized that the health care sector and the social and human services sector must work together to improve health in a real and sustainable way. Various policy levers and funding opportunities have helped align these sectors, though there is still work to be done. For example, the formation of Accountable Care Organizations (ACOs) incentivizes healthcare organizations to focus on the social determinants of health to ensure improved health outcomes among patient populations. Also, the Patient Protection and Affordable Care Act and IRS regulations require tax-exempt hospitals to conduct community health needs assessments encouraging a common understanding of community needs and assets. Around the country, HRiA has worked with multiple stakeholders to facilitate collaboration between health care organizations and human service providers to ultimately improve population health. Despite the interest, need, and opportunity for these sectors to work more closely together, we recognize that multiple challenges and barriers need to be addressed:
Greater awareness and understanding across sectors: Health care entities may be unaware of existing human services and their value, while human service providers may lack an understanding of health care payment and delivery systems. In our work, we consistently hear from health care institutions that they are unsure about what community and human services exist in their area and that they are unclear about which human service providers are providing high-quality, evidence-based services. As health care institutions weigh whether to “build” services internally or to “buy” external services, they require a greater understanding of the human services landscape in their patients’ communities. Echoing their health care colleagues, many community and human service providers have observed that health care institutions are not aware of their services and, sometimes, of their value and expertise, particularly in addressing the social determinants of health. Additionally, human service providers often lack the resources to actively market or sell their services to health care entities.
A related challenge that frequently arises is the fact that health care entities and human service providers historically speak different languages, have different approaches, and operate within different systems. In the context of health care reform, human service providers are now being asked to develop an understanding of complex healthcare payment and delivery systems in order to be paid. Although expertise in health care systems and payment mechanisms will be vital so that human service providers can enter into mutually beneficial arrangements with health care institutions, developing this level of expertise can be time and resource intensive.
The need for data systems to support two-way communication to coordinate care and to track metrics and outcomes: Both health care entities and human service providers express the need for information technology systems to track patient referrals to and uptake of external community resources, and to allow health care and community providers to share information about a patient or client. In addition to care coordination management, these sectors acknowledge the need to track metrics and outcomes relative to these referrals (how many patients were referred, how many patients received a service in a community setting, were there improvements in outcomes over time, etc.).
However, data systems for tracking and reporting outcomes are limited or do not exist. Health care entities frequently acknowledge HIPPA barriers to establishing such information-sharing systems while human service providers note that they have insufficient funding to invest in sophisticated data systems.
The impact that more systematic coordination and subsequent increase in referrals may have on social service capacity: Health care entities note that screening patients for social service needs and referring patients to external resources require appropriate staff, such as community health workers or community resource specialists, that do not exist in all settings. Human service providers note that their capacity to serve clients is often strained already and that waitlists are common. Given the potential for increased demand for human services with more streamlined referrals from health care entities, there is widespread concern that human service providers may not currently have the capacity to service additional clients in a timely manner.
To address these challenges to facilitate more robust integration and collaboration between the health care and social service sectors, HRiA proposes some solutions below. Such solutions can be large-scale, system-wide efforts, or they can serve as guiding principles for smaller entities and partnerships as they adapt to new delivery models:
1. Develop mechanisms to support the identification of potential partnership opportunities. Develop inventories of or designations for human service providers that meet certain requirements (e.g. human services providers that offer evidence-based services) and that can be easily accessed by health care entities looking for external partners. Bolster communication to strengthen relationships, identify common goals and processes, and develop mutually agreed upon referral pathways.
2. Identify common benchmarks and share health information technology platforms to optimize communication and information sharing between health care and community settings. Start by identifying benchmarks that are common for health care entities and human service providers. Building on these common benchmarks, it will be useful to identify health information technology best practices for collecting, tracking, and reporting outcomes. Next steps may then include leveraging existing electronic health record systems to grant access to human service providers, building platforms that allow for systematic tracking and reporting of social needs, and providing training for human service providers on tracking metrics and outcomes.
3. Assess and align human service provider capacity and health care institution needs. Systematically assess the capacity of both health care entities and human service providers to document current conditions and identify any recommendations and lessons learned. After assessing current capacity, next steps may include identifying any efficiencies or shared savings that can be realized through collaboration, having health care institutions centralize staffing resources for multiple practices (e.g., having a shared hub of community resource specialists), and/or supporting human service providers in identifying additional funding streams such as Community Benefits, Determination of Need,* and philanthropic dollars.
4. Build capacity across sectors to develop mutually beneficial relationships. Implement training and capacity building efforts for both health care and human service providers in identified areas to align processes and strengthen integration of services. For example, provide opportunities for technical assistance and learning collaboratives for human service providers on topics such as marketing services to health care entities, “translating” health care reform and systems terminology into lay language, monetizing services, and negotiating formal contracts and financial arrangements with health care entities.
Partnerships between the health care and human services sectors are limited but growing. These relationships have the potential to address “upstream” social determinants of health in addition to more traditional physical health conditions. It is worth the time and resources to address barriers to collaboration and integration between the health care and human services sectors, as these partnerships have immense potential for creating efficiencies through shared resources and achieving the common goal of improved population health.
*Determination of Need funding in Massachusetts requires hospitals to invest in their community based on substantial changes in capital expenditures