Despite high demand, access to quality and affordable mental health care remains a challenge for many Americans. Less than half of those with mental health illness receive care and only about 10 percent of those with substance use disorders receive treatment, according to the National Survey on Drug Use and Health. For people of color,…
Telling a complete patient story requires capturing the social determinants that influence overall health. Evidence suggests that focusing on “upstream” interventions outside of traditional clinical care—such as housing, neighborhood conditions, and increased socioeconomic status—can lead to overall improvements in health and reduce health disparities and inequities. The challenge for health systems is capturing and structuring…
Historically, the U.S. healthcare system has evolved based upon the presence of an “event”, i.e., the need for a visit – planned or impromptu – to a medical provider and/or facility. The inefficiencies, glut of utilization and exponentially rising costs that flow from it as funded by the long-standing “fee-for-service” (FFS) payment methodology have been…
When it was launched 56 years ago, Medicare became the first single-payer insurance program in the U.S., guaranteeing medical coverage to virtually every American once they turned 65. Medicare has proven to be a crucial feature of the U.S. safety net, providing healthcare services to tens of millions of Americans while helping to keep them…
On July 9, the Office of the National Coordinator for Health Information Technology (ONC), the federal agency that oversees health information technology, announced a long-awaited change that could help doctors and nurses provide better, more timely care for their patients. The agency released an updated version of the U.S. Core Data for Interoperability (USCDI), a…
Starting in 2020, Medicare Advantage plans will be allowed to offer supplemental, “non-primarily health-related” benefits to help certain eligible chronically ill patients with unmet social needs. Put simply, this represents a large source of reimbursement for social determinants of health (SDOH) solutions in the high-growth MA market. While this represents a real opportunity for SDOH…
People with complex care needs account for nearly one-fifth of all health care spending, even though they comprise only 1 percent of patients. These are individuals with multiple chronic conditions or functional limitations; people whose conditions carry significant nonmedical needs; and frail older adults. Their mental health, physical health, and social needs require coordination across numerous…
Accountable care organizations (ACOs) often care for many patients with complex, chronic conditions that can lead to high expenditures and utilization of care. In the United States, 1% of the population accounts for 21% of healthcare expenditures and the costliest 5% account for more than half of all health spending, according to a report published…
The transition to value-based care has expanded the definition of patient wellness to include both physical and social health. As patient care stretches into the community, the healthcare workforce begins to center on the community health worker. Community health workers “are frontline public health workers who have a close understanding of the community they serve,”…
Population health management and value-based reimbursement success hinge on reducing healthcare costs not only when a patient is in the exam room, but also when they are beyond the walls of the practice or hospital. Therefore, understanding where a patient lives, their income, education level, job status, and other social determinants of health (SDOH) is critical…