Improved health care system through integration of social and clinical services
At a recent event hosted by the Johns Hopkins Institute for Policy Solutions at the School of Nursing, the pros and cons of integrating clinical and social care services within Medicaid were discussed. This conversation focused on the largest source of health coverage in the U.S., with approximately 80 million people.
Pros:
Integrating clinical care with social services targets social determinants of health, such as housing, air quality, and food access, which significantly influence patient health more than clinical care alone. This integration could improve health outcomes by addressing root causes that clinical care often overlooks, for example, reducing asthma flare-ups by improving a patient’s living environment.
There is mounting evidence that these integrated approaches could also decrease overall health care costs by improving prevention, health promotion, and treatment effectiveness. Vincent Guilamo-Ramos, the institute's executive director and an expert in social determinants of health, stated that redefining the traditional boundaries of health care to integrate social care with clinical care under Medicaid could improve health outcomes and decrease costs.
Cons and concerns:
Expanding healthcare to include social services might inflate health care costs unnecessarily. Some experts worry about the operational and financial feasibility of integrating social services systematically into Medicaid programs. Challenges include establishing precise program boundaries, funding mechanisms, and ensuring accountability without increasing bureaucracy.
Chris Pope, a senior fellow at the Manhattan Institute, cautions against integrating social and clinical care using the predominant fee-for-service reimbursement model due to difficulties in pinpointing effective social care services. Pope notes that issues of health care, housing, and nutrition each have their own political and legal challenges, and solving them primarily through the lens of health care could lead to ineffective solutions.
The Role of Medicaid Section 1115 Waivers:
States and territories that integrate social care into their health care approach often use a tool called Medicaid Section 1115 waivers, which allow them to design and test innovative approaches for delivering services. In April 2022, North Carolina used a 1115 waiver to launch a pilot program offering food, housing, and transportation support to more than 13,000 people in three mostly rural areas. An independent evaluation of the North Carolina program found a statistically significant reduction in emergency department visits and hospitalizations among program participants, resulting in savings of $85 per person per month.
The Importance of Nurse Leadership:
The discussion at the Johns Hopkins University Bloomberg Center in Washington, D.C., emphasized the importance of nurse leadership in this integration effort. Guilamo-Ramos, the institute's executive director, emphasizes the value of a team-based model of care driven by nurses, who have the skills and trusted relationships with patients, families, and communities to optimize the value of integrated clinical and social care. Kody Kinsley, former secretary of the North Carolina Department of Health and Human Services and the senior policy advisor at the Institute for Policy Solutions, stated that these savings are significant, especially as states are looking for ways to curb costs per managed care.
In conclusion, the dialogue reflects a growing consensus toward integrated care models in Medicaid as a promising but complex reform approach. Careful design and precise targeting will be essential to balance benefits against expenses and complexity. The event highlighted the need for further research and exploration to determine the optimal approach for integrating clinical and social care services within Medicaid.
[1] Guilamo-Ramos, V., Kinsley, K., & others. (2022). Integrating Social and Clinical Care Services within Medicaid: A Promising but Complex Reform Approach. Johns Hopkins University School of Nursing.
- Integrating clinical care with social services as part of Medicaid can address social determinants of health, such as food access, housing, and air quality, potentially improving health outcomes.
- Evidence suggests that such integrated approaches could also lead to decreased overall healthcare costs by improving prevention, health promotion, and treatment effectiveness.
- However, concerns arise regarding the operational and financial feasibility of integrating social services systematically into Medicaid programs, with challenges like defining program boundaries, funding mechanisms, and maintaining accountability without bureaucracy.
- The use of Medicaid Section 1115 waivers allows states and territories to design innovative approaches for delivering integrated services, as demonstrated by North Carolina's pilot program offering food, housing, and transportation support.
- This initiative showed a statistically significant reduction in emergency department visits and hospitalizations among participants, resulting in significant monthly savings.
- Nurse leadership is crucial in the integration effort, with nurses' skills and trusted relationships with patients, families, and communities enabling optimal value from integrated clinical and social care.
- The discussion underscores the need for further research into the best approach for integrating clinical and social care services within Medicaid, to strike a balance between benefits, expenses, and complexity.
- The growing consensus towards integrated care models in Medicaid highlights the need for continued exploration and investigation in areas like science, health-and-wellness, fitness-and-exercise, mental-health, nutrition, education-and-self-development, social-media, entertainment, and politics, to inform general-news and policy-making.
