Study: Accountable care organizations find filling patients’ social needs difficult

Valley News Staff Writer
Published: 2/10/2020 10:02:35 PM
Modified: 2/10/2020 10:02:31 PM

LEBANON — One key to improving people’s health is to ensure that their social needs are met, but a recent study led by a researcher at The Dartmouth Institute for Health Policy and Clinical Practice found that accountable care organizations, which are central to the effort, often find it difficult to bridge the gap between health care providers and social service organizations.

The study published Feb. 6 in the journal Health Affairs found that ACOs — groups of health care providers that have contracts with health insurers to make per patient payments for keeping people healthy rather than based on the amount of medical care provided — often lack sufficient information about their patients’ social needs and the capabilities of community partners.

Researchers found that ACO’s partnerships with community groups are still in early stages and ACOs find it challenging to evaluate the return on investment of money targeted to needs that include access to food, transportation and companionship.

“Work to integrate social services with routine medical care is still in its infancy,” wrote the authors, led by Dartmouth Institute research scientist Genevra Murray.

The researchers conducted phone interviews with leaders of 19 ACOs in 2017 and conducted repeated site visits at three ACOs from 2015-18. The national sample included ACOs from around the country, which are identified only by number and region to allow them to speak freely about their business practices, Murray said. She could not say whether ACOs from Vermont or New Hampshire participated in the study. Officials from OneCare Vermont, the state’s only ACO, said they did not participate.

Most of the ACO leaders that participated in the study described the need to address patients’ social needs in order to improve their health and to bring down overall health costs, but they weren’t always sure how to do it.

Most ACOs in the sample, 95%, were working to address patients’ transportation needs. Many also were working to help people access food, 86%; and housing, 77%. Smaller percentages were working on economic hardship, health literacy, social support for loneliness, safety, legal services and employment.

“I would say that most of our respondents would identify transportation as more discrete and clear as to how you would address it in comparison to employment,” Murray said in a Monday phone interview. “Not to say that transportation is not challenging.”

OneCare CEO Vicki Loner said that community organizations such as mental health agencies, parent-child centers, home health agencies, agencies on aging and housing authorities have been a part of OneCare since early on.

“It really does take a village,” Loner said.

Even with that early participation, Loner said it’s still challenging to integrate the medical system with social service organizations. For example, Loner said OneCare, which was formed by Dartmouth-Hitchcock Health and the University of Vermont Health Network, has been working to incorporate things such as income information into the electronic medical record to provide a clearer picture of what patients’ needs are.

OneCare — which has come under scrutiny from State Auditor Doug Hoffer for how it is tracking “community-based” initiatives — is still sorting out which social service efforts are worth an ongoing statewide investment and which are more of a local effort, simply in need of seed money to get off the ground.

There are some early signs that some OneCare-supported efforts such as a psychiatric urgent care project in Bennington, which aims to prevent children from going to the emergency department when they’re experiencing mental health crises, seem to be having the desired effect.

But: “There is a lot of work to be done,” Loner said. “We’ve got to give it some time.”

Susan Barrett, executive director of the Green Mountain Care Board, the regulatory body overseeing Vermont’s health reform efforts, said that the advantage for Vermont is that it’s a small state.

“All of the stakeholders in health care talk and coordinate a lot,” she said.

But, like Loner, she said it will take time to know whether the investments are making a difference. And, in the end, Barrett said such efforts may not bring down costs, but they likely will improve people’s quality of life.

“Focusing on the social determinants of health is the right thing to do,” Barrett said.

Murray and her co-authors identified three primary areas for future focus, including long-term, sustainable funding; offering regional networking opportunities to bring together health care and social service providers; and standardizing the data that is gathered on community-based organization’s services and quality.

Nora Doyle-Burr can be reached at or 603-727-3213.

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