Improved Combinations of Social and Medical Care Might Revolutionize our Healthcare Infrastructure

Improved Combinations of Social and Medical Care Might Revolutionize our Healthcare Infrastructure

In a groundbreaking event hosted at the Johns Hopkins University Bloomberg Center in Washington, D.C., experts gathered to discuss the pros and cons of integrating clinical and social care within the Medicaid program. Vincent Guilamo-Ramos, the executive director of the Institute for Policy Solutions, envisions a reimagined health system that effectively meets the clinical and social needs of everyone, which he describes as a game changer.

Guilamo-Ramos, an expert in social determinants of health, 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 integrated clinical and social care. This approach can improve health outcomes and lower costs, according to supporters.

The Medicaid Section 1115 waivers allow states and territories to design and test innovative approaches for delivering services, including integrating social care into their health care approach. These waivers have been instrumental in enabling Medicaid programs to innovate by deploying demonstration waivers and managed care contracts to reimburse and support non-traditional social services. This leads to better integration and coordination across medical and community-based services.

One such example is North Carolina's use of a 1115 waiver to launch a pilot program offering food, housing, and transportation support to over 13,000 people in three rural areas. Early evaluations of this program show increased screening for social needs and reductions in those needs among participants, suggesting improvements in health outcomes.

However, integrating social care into the Medicaid program presents challenges. Chris Pope, 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 for entitlement programs. There are challenges ensuring enough qualified caregivers and providers, especially in remote or underserved areas, and winter conditions or geographic barriers can limit nonfamily caregiver availability.

Addressing these challenges is crucial, as integrating social care can lead to significant cost savings. Home- and community-based services (HCBS), which often include social care components, typically cost less than institutional care, sometimes less than half the cost. This savings is significant, especially for states looking to curb costs per managed care.

In addition to cost savings, integrated care can provide culturally responsive services, flexibility and community-based options, and increased care coordination. However, states and tribal entities face complex regulatory and administrative hurdles to implement HCBS and social care integration, such as establishing appropriate elder abuse codes or agreements with state authorities.

Despite these challenges, proponents argue that effective integration can lead to better health outcomes and the elimination of unnecessary costs. Guilamo-Ramos suggests three areas for integrated care innovation: a reimagined system, bridged infrastructure, and a strengthened safety net. The bridged infrastructure should ensure continuity of services across a holistic set of health-related social needs, and optimal involvement of the sectors best positioned to impact positive outcomes.

In summary, integrating social care into Medicaid can improve beneficiary outcomes and reduce costs by addressing social determinants of health and enabling care in less costly settings. However, challenges persist in ensuring sufficient caregiver availability, managing quality, and navigating complex program requirements. Existing pilot programs and waiver authorities offer emerging evidence supporting this approach’s potential effectiveness.

1. The event at Johns Hopkins University Bloomberg Center focused on integrating clinical and social care within the Medicaid program.
2. Guilamo-Ramos envisioned a reimagined health system that addresses both clinical and social needs of individuals.
3. He advocates for a team-based model of care led by nurses to optimize integrated clinical and social care.
4. Improved health outcomes and lowered costs are the benefits of integrating clinical and social care, according to supporters.
5. Medicaid Section 1115 waivers allow states to design innovative approaches for delivering services, including integrating social care.
6. North Carolina introduced a pilot program offering food, housing, and transportation support to over 13,000 people in rural areas with this waiver.
7. Early evaluations of this program showed increased screening for social needs and reductions in those needs among participants.
8. Integrating social care into the Medicaid program poses challenges like difficulties in pinpointing effective social care services and ensuring qualified providers.
9. Home- and community-based services typically cost less than institutional care, offering significant cost savings.
10. Integrated care can provide culturally responsive services, flexibility, community-based options, and increased care coordination.
11. States and tribal entities face challenges such as establishing appropriate elder abuse codes or agreements with state authorities for HCBS and social care integration.
12. Effective integration can lead to better health outcomes and the elimination of unnecessary costs.
13. Guilamo-Ramos proposed three areas for integrated care innovation: a reimagined system, bridged infrastructure, and a strengthened safety net.
14. The bridged infrastructure should ensure continuity of services across a holistic set of health-related social needs.
15. The optimal involvement of sectors best positioned to impact positive outcomes is necessary for integrated care innovation.
16. Challenges persist in ensuring sufficient caregiver availability, managing quality, and navigating complex program requirements in integrated care.
17. Existing pilot programs and waiver authorities offer emerging evidence supporting the potential effectiveness of integrating social care.
18. Integrating social care into Medicaid addresses social determinants of health and enables care in less costly settings.
19. employers increasingly prioritize workplace-wellness programs by incorporating health-and-wellness initiatives focused on mental-health, fitness-and-exercise, and chronic-conditions like chronic-kidney-disease and cancer.
20. In recent years, there has been growing interest in eye-health, skin-care, and nutrition within education-and-self-development and personal-growth communities.
21. As we learn about the impact of social care integration on health outcomes and costs, it's essential to promote policy-and-legislation that enables greater access to integrated care, including online-education opportunities and resources for job-search and career-development.

Read also: