Page 2
The Industry
Successfully Incorporating
Social Determinants
Continued from cover.
Addressing all the issues affecting an
individual’s health requires adopting a holistic
picture of their needs and developing an
integrated method for delivering the services
they require. It takes organizing agencies
to deliver integrated services, analyzing
outcomes and continually improving
management and delivery processes. And
the effort can help states, counties and cities
deliver better outcomes for citizens while
controlling expenditures across programs.
This expanded view of individuals
should be combined with a high-
level view of the issues facing
the groups in which individuals
reside. These groups are
communities, cities, states, ethnic
or socioeconomic groups; they
can even be users of a hospital,
managed care organization
or other healthcare delivery
systems. Because our health is
affected by the environment in
which we reside, it is important to
understand and improve the home
and community environments.
Integrated service delivery – supported
by an approach to healthcare that
understands population health and
addresses its needs – will further ensure
that healthcare resources can promote
better outcomes and reduce costs and
health disparities over time. It’s important
to remember that population health is more
than the overall health of a population; it
also includes the distribution of health.
1
In
an ideal delivery system, differences within
the group are substantially eliminated or
reduced. This moves the group as a whole
toward improved health outcomes.
Assessments of healthcare delivery and
outcomes in the United States reveal many
opportunities for improvement. Pricing and per
capita healthcare costs for health services are
generally higher than in other industrialized
nations. Yet we “devote a relatively small share
of [our] economy to social services, such as
housing assistance, employment programs,
disability benefits and food security.”
2
At the
same time, measures such as life expectancy
and chronic disease levels in the U.S. are some
of the worst among developed nations. (For
more information, see the chart above.)
However, conditions have improved
recently. A Commonwealth Fund issue
brief
3
states that federal and state policy
environments appear favorable for integrating
health and social services for many reasons.
For one, there is the expansion of Medicaid
(as of December 2015, 31 states and the
District of Columbia have expanded, four
states are discussing it and 16 have declined).
There is also the Affordable Care Act’s (ACA)
focus on delivery and payment reform
supported by the Center for Medicare and
Medicaid Innovation within CMS; the Center’s
efforts often focus on coordinated, patient-
centered care. Finally, more providers want
to address patients’ unmet social needs.
Their support will continue to grow as
providers bear more responsibility for
health outcomes and financial results. This
environment has provided a foundation for
continued service integration.
The ACA also established the National
Prevention, Health Promotion and Public
Health Council and the Prevention and
Public Health Fund. These groups help
prioritize population-wide health concerns
for healthcare programs across the country,
including tobacco-free living, drug abuse
prevention, healthy eating, active living,
injury and violence-free living, reproductive
and sexual health and mental and
emotional well-being.
4
Health and Social Care Spending as a Percentage of GDP
Percent
40
30
20
10
0
Notes: GDP refers to gross domestic product.
Source: E.H. Bradley and L.A. Taylor.
The American Health Care Paradox: Why Spending More is Getting Us Less
. Public Affairs, 2013.
FR SWE SWIZ GER NETH US NOR UK NZ CAN AUS
Healthcare Social Care
12 12
12
11 11
16
9
9
9
10
8
21 21
15
20 18
9
16
11
11
10
15
