What PCAs and BHSAs can do to Understand the Social Health Landscape in their States

Addressing social factors is in the DNA of both community health centers and community-based behavioral health organizations. Responding to health-related social needs has always been an important part of safety-net healthcare and is codified in Patient-Centered Medical Home and Certified Community Behavioral Health Clinic standards. The rest of the health care system is now catching up and imposing new expectations and incentives regarding standardization, universality, reporting, and population-level analytics related to social health screening data.

Social health is also an important consideration for Delta Center primary care and behavioral health state association grantees working to design and implement approaches to addressing health and behavioral health services integration and structural racism. Within this context, social health expert and Delta Center phase 1 grantee Ariel Singer led a virtual learning session focused on hot topics in social health this year for PCAs and BHSAs. Ariel reviewed the state of the science on social health screening, strategic frameworks for social health integration, and what’s new in social health in 2023. You can access a condensed version of her presentation here.

Key takeaways from the session include:

1. Social health goes well beyond identifying social risks (awareness) and includes tailoring care to accommodate social barriers (adjustment), connecting patients with resources (assistance), leveraging or investing in community assets to address social needs (alignment), and promoting policies that change underlying infrastructure related to social needs in the community (advocacy). PCAs and BHSAs could work in any or all of these domains. More about these key domains for social health integration can be found in the National Academies for Science, Engineering, and Medicine 2019 report on Integrating Social Care into the Delivery of Health Care.
2. While there are many different social needs screening tools available, no single tool has been comprehensively validated using gold standard approaches. While more research is needed to provide robust evidence for screening tool selection, resources exist to help select the one that will work best for your state context.
3. Many health care professionals have concerns about screening in the absence of adequate resources to respond to patient needs. Patients, however, generally find social screening acceptable, although patients with prior experiences of healthcare discrimination express lower acceptability of social screening. Concerns can be mitigated through appropriate measures to protect privacy and reduce stigma.
4. Food, transportation, and housing are the most frequently screened for social needs, but tools are available to screen for many more.
5. Medicaid managed care plans are increasingly being held accountable for social needs screening and intervention through their state contracts.
6. Under CMS guidance, many states are beginning to leverage Medicaid waivers and concepts such as “in lieu of services” to address social health needs.

What should PCAs and BHSAs do next to continue advancing social health knowledge and action in their states?

As a follow-up to the event, consider these key questions and resources for what your state association can do to continue advancing knowledge and action on social health integration.

Key questions for your state social health landscape:

• What is your state Medicaid office doing related to social health screening and referral?
• What are your members doing in the realm of social health screening and referral?
• What non-Medicaid social health activities in your state should you be aware of? Examples may include community organizations, such as a local food bank, working to integrate screening and referral in health care settings, or implementation of a Community Information Exchange platform to facilitate electronic referrals between health care and social service organizations.
• How can understanding social health in your state inform your Delta Center work?

Inspired to delve deeper into social health integration and policy change? Here are some ideas and examples from early adopters

How can Medicaid programs use policy to address social needs?

• Letter from the Centers for Medicare & Medicaid Services describing how states may address social determinants of health under current Medicaid flexibilities
• Report from the Robert Wood Johnson Foundation’s State Value and Strategies program with examples of approaches states are taking through their Medicaid managed care programs to address health-related social needs

How can states leverage in lieu of services to get funding for addressing social needs?

• Letter from the Centers for Medicare & Medicaid Services to state Medicaid directors about using in lieu of services to address unmet, health-related social needs
• California: List of 14 Community Supports (in lieu of services) Medi-Cal managed care plans can provide, which is supported through 1915(b) and 1115 waivers
• New York: List of in lieu of services for approved for Medicaid managed care plans