Underestimated challenges for social care initiatives — regulatory compliance

In a growing number of U.S. communities, one available health plan offers a suite of services to address members’ social needs (such as food, housing, and transportation) while another plan serving a sociodemographically identical population does not. Understanding how institutional decisions are made about social care is critical to achieving equitable implementation. Qualitative research has identified challenges to implementing social care that are largely related to organizational capabilities, up-front capital for responding to patients’ social needs, and uncertainty about the return on investment of social care programs. A key underexplored factor is health care regulatory compliance: relevant regulatory considerations affect social care program design, promotional activities and communications, fraud and abuse risk management, and management of social services vendors. In all these areas, legal frameworks create real and perceived hurdles that shape decisions regarding social care activities.