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Four ways to overcome partnership hurdles and address social determinants of health

D. Flynn, J. Price
Nonprofit Finance Fund

Health care costs can be reduced and health outcomes improved by investing in non-clinical interventions that address the social determinants of health (SDOH) surrounding a person’s life. This is not a new concept. What has changed over the last few years is that increasingly flexible payment methodologies allow health care payers (health plans) and providers (hospitals, clinics, physician groups) to invest in these approaches by partnering with social care providers, often nonprofit community-based organizations, that offer services to address issues such as food, housing insecurity, transportation, etc. These payment methodologies include a wide variety of models, mostly under the umbrella of value-based contracting, including bundled payments, capitated arrangements, and value-based contracts. Federal and state governments, under both Republican and Democratic control, are broadly continuing this move to value, albeit at different rates.

There is much to learn from these early efforts to implement contracts that directly address SDOH. Over the past several years, we have worked closely with a cohort of community-based organizations providing critical social services as they partner with healthcare payers and providers. We’ve seen the triumphs and frustrations of these early projects as change agents push the boundaries of systems that have not been pushed in this way before. Yet despite confidence in the value of addressing SDOH, implementation of interventions has moved at a pace slower than expected. In New York State, one of the earliest adopters of innovative payment structures for SDOH investments, just over 100 contracts have been approved by the State Department of Health for the Medicaid program’s 7 million members.

So what is causing this disconnect between dreams and reality? A few core challenges have emerged across the work we have done to help SDOH providers enter into contractual arrangements, including cultural, data-related, and funding challenges. Here are four opportunities for organizations invested in SDOH partnerships to speed success.

Flynn D, Price J. Four Ways to Overcome Partnership Hurdles and Address Social Determinants of Health. Nonprofit Finance Fund; November 20, 2020. Available online.

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