Cross-Sector Partnerships to Address Health-Related Social Needs

Surveying the landscape of cross-sector partnerships between healthcare and social services, researchers from The Commonwealth Fund identified common challenges and proposed solutions to better address health-related social needs.

Communities across the country have been creating partnerships between healthcare providers and community-based organizations (CBOs) in an effort to enhance health-related social needs, such as housing, food insecurity, and assistance with utilities and transportation.

“Effectively managing patients with complex clinical and social needs requires thoughtful integration of healthcare and social services,” wrote the researchers. “Research has shown that patients with multiple clinical and social needs consume a large share of healthcare services. Social services providers, though historically disconnected from the broader health system, play an important role in providing services for these patients.”

The researchers identified programs that target socially vulnerable, high-utilization, or medically complex populations. Of the 301 cross-sector community partnerships that met the authors’ criteria, 64 were evaluated using web surveys and in-depth interviews.

The researchers evaluated the advances of the programs in 4 dimensions: coordination, financial alignment, data- and information-sharing, and metric reporting. They found that while programs differ in significant ways, they face the same common challenges. Identifying these challenges, the authors came up with solutions going forward.

Since many programs are grant funded, they may not be sustainable once the funding stops, and cost savings and improvement in outcomes may be difficult to sustain since there will be less room for improvement. The researchers propose payment reform around transitional care activities and population health, as well as a coalition of CBOs establishing alignment with hospitals’ strategic plans.

The researchers also found that there is a lack of infrastructure and know-how to define and measure the most relevant outcomes and to accurately estimate cost savings. To counteract this, the researchers recommend establishing a common data dictionary and data set requirements across hospitals, health systems, and community-based organizations with common methods for analysis.

Another challenge the authors found was that there are limited mechanisms and knowledge of how to share savings. They propose identification of local philanthropies, foundations, and trusts that would provide funding to accelerate experimentation around financial partnerships, and focus on areas where health systems are subject to potential financial penalties or incentives.

Struggling with data and technology expertise, many CBOs lack a technical platform, infrastructure, and know-how to integrate data from different sources. The researchers recommend utilizing workflow case management systems at the CBO-level that could integrate with electronic medical record systems and use hospitals’ data and technology expertise to serve as anchors for community efforts.

Many programs struggle to define cross-sector, multiorganization, clinical, and social workflows. The proposed solution by the authors is demonstration grants that provide critical support to experiment and establish the evidence base; and national collaboratives, learning networks, and information clearinghouses.

“To implement solutions, federal and local policymakers, philanthropic agencies and foundations, and local anchor hospitals must continue to provide support, funding, and expertise,” wrote the researchers.

Many have advocated for addressing social determinants of health in order to improve overall health quality, citing determinants, such as access to food, housing, and transportation, that can intensify healthcare disparities. These advocates push for an approach that encourages community collaboration and ongoing alignment and improvement.