ACOs Face Substantial Challenges in Integrating Social Services with Patient Care

There is a growing recognition among payers and providers that social determinants of health—the social and socioeconomic factors that influence a patient’s care, such as income and access to transportation—are strongly linked to health outcomes. This recognition has been reinforced by a shift toward value-based payments, which incentivizes improved health outcomes rather than service delivery alone. Although it is evident that mitigating adverse social determinants can have a positive impact on patient outcomes and curb spending, results from a recent study reveal that Accountable Care Organizations (ACOs) face substantial challenges in integrating social services with patient care (Murray GF, et al. Health Aff (Millwood). 2020;39:199-206).

To understand how a group of ACOs fared at addressing their patients’ social needs, the researchers collected qualitative data from 22 ACOs across the United States. The qualitative data were gathered through phone interviews with 19 ACOs in 2017; this information was supplemented with longitudinal data obtained during site visits to 3 ACOs in the period between 2015 and 2018. The researchers found that, although these organizations were highly committed to working on initiatives to address social determinants of health, they still faced significant challenges in terms of social service integration. Specifically, most of the ACOs in the sample lacked necessary data on their patients’ needs and on the capabilities of potential community partners that would facilitate effective decision-making. They also found that partnerships between ACOs and community-based organizations, although vitally important, were still in the early stages of development. Furthermore, innovation was constrained by ACOs’ challenges in determining how best to approach return on investments in social services, because of the shorter funding cycles and more lengthy time horizons to see results.

The researchers concluded that “the cohort of early-adopter ACOs are struggling in their work on social service integration, despite effort and attention” and that the obstacles to effective integration are significant. “Policies that could facilitate the integration of social determinants include providing sustainable funding, implementing local and regional networking initiatives to facility partnership development and developing standardized data on community-based organizations’ service and quality to aid providers that seek partners,” they added.

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