National Academies: CMS should mandate payment of social services for health

Medicare spending costs money
The National Academies releases recommendations for integrating social needs into Medicare and Medicaid. (Getty/zimmytws)

The healthcare system, government agencies and other organizations should be setting guidelines that integrate people’s social needs into insurance coverage, according to a new report from the National Academies of Sciences, Engineering and Medicine.

The report, Integrating Social Care into the Delivery of Healthcare, contains five goals that all healthcare systems and government agencies should be using as guidelines to integrate social needs into insurance coverage.

As more and more studies reveal the link between housing, access to healthy food, transportation, education and other social determinants to a person’s health, the healthcare and insurance systems still seem to be playing catch-up when it comes to offering these services and paying for them.

In fact, for every $1 the U.S. spends on healthcare, about $.90 goes to social services, according to the report. In other industrialized countries, every $2 that goes to social services, another $1 is spent on healthcare. But in order to change the habits in the U.S., the system needs to better define what is considered social care and make sure these activities are covered under payment plans.

“Health insurance companies are starting to recognize, if not already actively addressing, the importance of integrating social needs into their overall health and wellness strategies for their members,” Chris Esguerra, M.D., senior medical director at Blue Shield of California, told FierceHealthcare. “Still, there is more work to be done in this area. Foremost, health plans need to recognize the importance of social needs care as part of achieving overall health and wellness of individuals and communities, followed by a commitment to address those needs with specific steps and strategies.

In addition, Esguerra notes that while the 2018 CHRONIC Care Act enabled Medicare Advantage health plans to add supplemental benefits that can address social needs, not many health plans expanded these supplemental benefits for 2019.

“Health plans should take full advantage of the flexibility provided under the CHRONIC Care Act for supplemental Medicare benefits to address social care,” he said.

RELATED: States lack guidelines on Medicaid funding for social services

The report defines workforce, data and technology, and new financing models as three key necessities to changing the current system. The National Academies recommends the following steps in working towards these key initiatives:

First, the U.S. needs to better integrate social care by identifying the people most in need, including social care providers as a part of healthcare teams, and establishing financial referral relationships between healthcare and social care divisions.

The second step is to train and engage the healthcare workforce and social care professionals in schools, homes and community-based organizations. This requires the development and standardization of social care workers. Also, these workers should have the proper continuing education to handle the integration of social and medical care.

The third step, as outlined by the report, is developing an infrastructure for data sharing between healthcare and social care workers. This method would require the Office of the National Coordinator for Health Information Technology (ONC) to help define the best way to share data. Plus, working with the Federal Health Information Technology Coordinating Committee to share data on health, housing and education. In addition, the Department of Health and Human Services would work with the private sector to disseminate tools for guidance and security and privacy when collecting data.

Fourth, the report recommends that the Centers for Medicare & Medicaid Services (CMS) to define which aspects of social care that Medicaid can cover, make these opportunities and limitations clearly written into health plans, and incentivize healthcare organizations and managed care programs to collaborate with community-based social services.

in designing payments, the report highlighted several recommendations for financing health and social integration, including that CMS should clearly define which aspects of social care that Medicaid can cover and Medicaid should use flexibility in the social care that programs pay for and make these opportunities flexible on health plans. 

Plus, CMS should accelerate learning on how integration can reduce healthcare costs by encouraging and approving waivers that support social care, the report suggests. States and the feds will need to work together to address the needs of dually eligible beneficiaries, too, according to the report.

RELATED: Kaiser Permanente launches network for social health services

"The financing model for social care integration is crucial to its success, and the report makes several recommendations of how financing could be adapted to facilitate social care integration," Committee Chair Kristen Bibbins-Domingo, M.D., a general internist and vice dean for population health and health equity at the University of California San Francisco, told FierceHealthcare.

The fifth and final step would be funding research and evaluations on the effectiveness and implantation of social care practices in healthcare settings.

“Taking into account the social conditions in which a person lives, works and plays is critical to health. The committee’s recommendations provide guidance to policymakers, health system leaders and other stakeholders on moving forward with integrating social care into healthcare delivery to address social needs among people and populations,” the report concluded.