Revising the Logic Model Behind Health Care’s Social Care Investments

Tags:
Early View Perspective
Topics:
Social determinants of health Integrated care

Policy Points:

  • This article summarizes recent evidence on how increased awareness of patients’ social conditions in the health care sector may influence health and health care utilization outcomes.
  • Using this evidence, we propose a more expansive logic model to explain the impacts of social care programs and inform future social care program investments and evaluations.

Over the last decade, health care sector activities related to identifying and addressing patients’ social drivers of health have graduated from being innovative and leading-edge practices to being norms and expectations. Key examples include policies from health care payers and professional standard–setting organizations—including the Centers for Medicare and Medicaid Services (CMS), the National Committee for Quality Assurance, and The Joint Commission—signaling that standardized social risk screening and, in some cases, navigation to social services, are now considered a basic standard of care.1 The emergence of these and other state and federal health care standards, regulations, and quality measures related to social drivers of health2 stems from strong and compelling evidence linking social adversity with poor health outcomes3-8 and increasingly leverages the health care sector’s adoption of value-based payment models that reward quality over quantity of services.9, 10

References

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  2. Whitman A, Lew ND, Chappel A, Aysola V, Zuckerman R, Sommers BD.Addressing social determinants of health: examples of successful evidence-based strategies and current federal efforts. Office of the Assistant Secretary for Planning and Evaluation. April 1, 2022. Accessed January 11, 2024. https://aspe.hhs.gov/reports/sdoh-evidence-review
  3. Commission on Social Determinants of Health.Closing the Gap in a Generation:Health Equity Through Action on the Social Determinants of Health: Final Reportof theCommission on Social Determinants of Health. World Health Organization;2008.
  4. Green H, Fernandez R, MacPhail C. The social determinants of health and health outcomes among adults during the COVID-19 pandemic: a systematic review.Public Health Nurs. 2021;38(6):942-952.
  5. Hood CM, Gennuso KP, Swain GR, Catlin BB. County health rankings: relationships between determinant factors and health outcomes. AmJPrevMed.2016;50(2):129-135.
  6. Marmot M. Health in an unequal world. Lancet. 2006;368(9552):2081-2094.
  7. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death inthe United States, 2000.JAMA. 2004;291(10):1238-1245.
  8. Parekh T, Xue H, Cheskin LJ, Cuellar AE. Food insecurity and housing instability as determinants of cardiovascular health outcomes: a systematic review. Nutr Metab Cardiovasc Dis. 2022;32(7):1590-1608.
  9. Burwell SM. Setting value-based payment goals–HHS efforts to improve U.S.health care.N Engl J Med. 2015;372(10):897-899.
  10. Milad MA, Murray RC, Navathe AS, Ryan AM. Value-based payment models in the commercial insurance sector: a systematic review.Health Aff (Millwood).2022;41(4):540-548

Citation:
Gottlieb LM, Hessler D, Wing H, Gonzalez-Rocha A, Cartier Y, Fichtenberg C. Revising the Logic Model Behind Health Care's Social Care Investments. Milbank Q. 2024;102(2):0125.