SDoH: Service Gaps Apparent Among ACOs

Industry studies highlight large investments, yet ACOs struggle to integrate SdoH.

Several major research studies have emphasized the large sums being spent by healthcare organizations to better manage the social determinants of health (SDoH), amid ongoing struggles to mitigate service gaps, especially by Accountable Care Organizations (ACOs).

A study published in Health Affairs explored the degree to which U.S. health systems have directly invested in community-based efforts. Researchers scoured public announcements of new programs involving direct financial investments associated with the SDoH by U.S. health systems from the time period of Jan. 1, 2017 to Nov. 30, 2019.

Hefty investments were found across health systems and the five main SDoH domains, encompassing:

• 78 unique programs involving 57 health systems that included 917 hospitals
• $2.5 billion of health system funds, of which $1.6 billion in 52 programs was dedicated to housing-focused interventions.
  • Other areas of attention were:
    • 28 employment programs, at investments of $1.1 billion
    • 14 education programs, at $476.4 million
    • 25 food security programs, at $294.2 million
    • 13 social and community context programs, at $253.1 million
    • 6 transportation programs at $32 million

Health systems are clearly making sizable investments in these areas.

The three largest investments were by Kaiser Permanente for $760 million, the Johns Hopkins Health System for $162 million, and MetroHealth in Cleveland for $160 million.

The research excluded programs in which health systems used:

• Only funds granted by other organizations
• Programs providing direct medical care, subsidized unfunded care, or funded medical education
• Those focused only on the healthcare domain, except if providing transportation to enhance health care access
• Those creating or implementing dedicated screening or referral tools
• Hospital renovation programs
• Programs that increased the minimum wage
• Those involving community investments by financing agencies or insurance payors

ACOs Behind the Curve

On another note, data from a recent Dartmouth study shows that despite strong efforts, ACOs continue to struggle integrating social services and medical care. The study pulled qualitative data from 22 ACOs, and used phone calls and site visits, the latter lasting anywhere from 3-5 days. The study also reflected diverse payor populations across the country. While there was high awareness of the importance of addressing the SDoH, the ACOs were way behind the curve:

• Few had formal programs or contracts in place to address social needs. Those with contracts did not adequately specify target populations. 
• Few had a clear idea of the social needs of their patients.
• The quality and availability of community-based organizations (CBOs) has been less than optimal.
• Only 50 percent are doing a standardized screening of social needs.

Considering the strong value-based care emphasis by ACOs, the data has demonstrated surprisingly low awareness of how care and costs connect for the SDoH populations. With such strong industry attention to the development of cross-sector collaboration, partnerships with CBOs can become a solid way to address the social needs of any community.

Programming Note: Listen to Ellen Fink-Samnick’s live reporting on the State of the Social Determinants weekly on Monitor Mondays, 10-10:30 a.m. EST.