A research paper by a team of researchers has found that the development of accountable care organizations, particularly ACOs participating in the Medicare Shared Savings Program (MSSP), has not in itself advanced the development of work on social determinants of health (SDOH). That’s the conclusion of a paper published in the July issue of Health Affairs.
The authors, Dhruv Khullar, William L. Schpero, Lawrence P. Casalino, Reekari Pierre, Samuel Carter, Yasin Civelek Manyao Zhang, and Aelia M. Bond, write in “Meeting the needs of socially vulnerable patients: Insights from ACO leaders on moving from intent to action”—that “The Centers for Medicare and Medicaid Services have placed increasing emphasis on the social drivers of health, but little is known about how accountable care organizations (ACOs) seek to meet the needs of vulnerable patients.”
Related to this, they write: “During September-December 2022, we interviewed leaders of forty-nine ACOs participating in the Medicare Shared Savings Program (MSSP). Participants were asked about strategies for identifying socially vulnerable patients, programs that addressed their needs, and Medicare reforms that could support their efforts. Seven themes emerged: ACOs were in the early stages of collecting data on social needs; leaders were frustrated by an incomplete ability to act on such data; ACOs tended to stratify patients by medical, rather than social, risk; some ACOs have introduced pilot programs to address challenges including social isolation and drug costs; programs were often payer-agnostic; rural ACOs faced unique challenges; and Medicare reforms related to reimbursement, logistical support, quality metrics, and patient benefits could support ACOs’ efforts.” Given all that, “these findings suggest that the MSSP alone has not been sufficient to promote sustained investment in social needs provision in most ACOs. Policymakers may want to consider more direct support and incentives for health care organizations, or increased investment in non-health care sectors, to assist socially vulnerable patients,” they write.
What’s more, even Medicare’s Accountable Health Communities model, “through which organizations were incentivized to screen patients for social needs and refer them to social service providers, suggests the model has had mixed results,” the researchers write.
Ultimately, they conclude, referring to their research and findings across multiple dimensions, “these results, along with the perceptions of our interviewees, raise thorny questions about whether health care organizations are the appropriate mechanism for addressing social needs, or whether greater investment in other sectors, such as housing, transportation, or public safety, is a better strategy.”
