For decades, seniors and others with chronic illness have had to scale a seemingly insurmountable barrier built by the health care system, aided and abetted by Medicare and Medicaid.
On one side of the wall was medical care, mostly controlled by doctors, hospitals, drug companies, and skilled nursing facilities. Medicare paid them to do as many medical procedures as possible, and not surprisingly, that’s what they did.
On the other side: social supports such as community and family assistance, good nutrition, exercise, transportation, and safe housing—none of it paid for by Medicare. Some was funded by other government programs but not through physician practices.
For decades, many of the docs who controlled the medical side never saw much benefit in those social supports. They understood the importance of surgery, diagnostic tests, and pharmaceuticals. But the rest was fuzzy, hard to quantify social worker stuff. How does your primary care doctor write a prescription for someone to hold your hand, and how does she measure what good it does?
Finally, that’s beginning to change. Two new reports show just how mainstream the idea of social supports is becoming. Not just among consumers, or within the world of long-term care, but inside the medical profession.
The first comes from the United Health Foundation. Called “America’s Health Rankings Senior Report” the paper is one of those ubiquitous “best” and “worst” scorecards. This one measures which states are the healthiest for seniors. If you’re keeping track, Minnesota and Hawaii are at the top. Mississippi brings up the rear.
What’s most interesting is what the Foundation measures to come up with a “healthiest” score. Not surprisingly, some determinants are strictly medical, such as access to dedicated health providers, preventable hospitalizations, and the percentage of people getting flu shots.
But the United Health Foundation didn’t stop there. It also measured access to social supports, and the percentage of people who are getting good nutrition or are physically active. They even counted volunteerism as a key indicator senior health.
The message to both consumers and the medical profession: This stuff matters. Pay attention.
The second paper was published recently by The Commonwealth Fund, a foundation whose primary goal is improving the health system. While Commonwealth has always paid some attention to long-term care (they have even published one of my papers), medical care has always been its priority. But it too is starting to see the value of showing the link between social care and medical outcomes.
“Addressing Patients’ Social Needs: An Emerging Business Case for Provider Investment” aims squarely at that target And it was written, not by academics or social scientists, but by four top staffers from the legal and consulting firm Manatt, Phelps & Phillips—a firm whose clients include hospitals and state Medicaid programs.
The paper doesn’t break much new ground but does a good job describing programs that successfully integrate medical and social care.
For instance, Minnesota’s Hennepin Health is a partnership among providers, a health plan, and the county that receives a single payment to provide both medical care and social services. It reports significant reductions in both emergency room visits and hospital admissions.
Programs such as this are not necessarily aimed at seniors—many in fact target populations such as moms and kids—but the message is the same: Well-coordinated medical and personal care may both improve outcomes and save money.
We have a lot more to learn about how to combine these services and, in this early stage of a grand experiment, don’t know how much money they really can save. So the business case Manatt describes is only anecdotal. But the potential is there.
Many advocates for seniors and younger people with disabilities distrust new delivery models that fully integrate health and personal care because they fear the combination will medicalize social support.
That remains a risk, but it is also possible that a well-integrated model will acknowledge the value of personal assistance. There is a long way to go before medical providers really understand the importance of these supports for someone with chronic disease. But they may be starting to get it. And respected medically-oriented organizations are certainly telling them.
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