Community partnerships, payment changes must address social determinants of health

The idea of contextualized care has received more attention in recent years, but helping patients overcome social determinants of health remains a challenge for individual physicians and the healthcare community at large.

"People's stories matter," Monica Bharel, M.D., Harvard Medical School instructor in medicine at Massachusetts General Hospital and commissioner of the Massachusetts Department of Public Health, explained at a recent seminar about treating vulnerable populations, reported by Medical Xpress

"We know so much about the pathophysiology of diseases, but we know so much less about where a man should store his insulin when he sleeps under a bridge," she told attendees at the event hosted by the Center for Primary Care at Harvard Medical School and the HMS Department of Global Health and Social Medicine.

To overcome these health barriers, Bharel and her co-presenters agreed that healthcare providers' relationships with patients--to understand their struggles--and with community resources are essential.

Effective community partnerships, however, aren't a strong suit for a lot of healthcare organizations, Anna Roth, R.N., chief executive officer of Contra Costa Regional Medical Center and Health Centers in San Francisco, said in a recent interview with NEJM Catalyst.

"It is time we look beyond the four walls of our institutions and see how we can partner with those who have already mastered things like housing and employment. There are expert agencies, like the nationwide 211 program and other nonprofits, who are better at that than we're probably ever going to be," she said. "We should learn how to work with them. If these networks and organizations are not as strong as we would like them to be, maybe the role we can play is to be strong partners for them so they can strengthen themselves."

Money also matters, according to experts. At Contra Costa, for example, the health system is inching further away from fee-for-service (FFS) to value-based reimbursement systems, such as California's Delivery System Reform Incentive Payment Program, which is an innovation incentive that has fueled initiatives such as patient-centered medical home transformation, partnership with food and housing resources and alternative care offerings. Under FFS, these programs would have no mechanism for payment, Roth said.

To learn more:
- read the article from Medical Xpress
- see the article from NEJM Catalyst