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Suggested Citation:"8 Reflections on the Day." National Academies of Sciences, Engineering, and Medicine. 2019. Investing in Interventions That Address Non-Medical, Health-Related Social Needs: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25544.
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8

Reflections on the Day

To conclude the workshop, Daniel Polsky provided a short summary of the two key messages he heard throughout the day. The first was there is underinvestment in social needs. Speaking from the perspective of an economist, he said it is clear there are many places where the market does not function properly, such as in the case of the “wrong pockets” problem that several panelists mentioned and the long time frame over which returns for many interventions are realized. Value-based payment, he said, can be a wonderful approach for addressing this underinvestment because economic incentives do work.

The second key message was that more research is needed, and there is an opportunity to think about infrastructure that could lead to more rigorous, evidence-generating research. He noted the panelists had many great ideas around evidence standards, using more administrative data, addressing privacy issues, and making linkages across disciplines and organizations.

Polsky then opened the floor to comments from the workshop participants. One unidentified participant from the American College of Preventive Medicine suggested there are many places where preventive medicine specialists could serve as the bridge between clinical care and community needs. This participant also proposed that one infrastructure investment would be to offer cross-training during residencies for new physicians who want to work at the intersection of prevention and population health.

Another participant suggested there are other approaches to proving an intervention is effective, such as realist evaluation and Shewhart

Suggested Citation:"8 Reflections on the Day." National Academies of Sciences, Engineering, and Medicine. 2019. Investing in Interventions That Address Non-Medical, Health-Related Social Needs: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25544.
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statistics, that are not time-consuming, randomized controlled trials. A third participant suggested looking at systems-based interventions that are not traditionally thought of as addressing social determinants of health. As a final comment, Uche Uchendu said she would like to see more overt emphasis on health equity and health disparities in this work because the assumption that addressing social need and social issues will take care of health equity issues is usually incorrect.

Suggested Citation:"8 Reflections on the Day." National Academies of Sciences, Engineering, and Medicine. 2019. Investing in Interventions That Address Non-Medical, Health-Related Social Needs: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25544.
×
Page 77
Suggested Citation:"8 Reflections on the Day." National Academies of Sciences, Engineering, and Medicine. 2019. Investing in Interventions That Address Non-Medical, Health-Related Social Needs: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25544.
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Page 78
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With U.S. health care costs projected to grow at an average rate of 5.5 percent per year from 2018 to 2027, or 0.8 percentage points faster than the gross domestic product, and reach nearly $6.0 trillion per year by 2027, policy makers and a wide range of stakeholders are searching for plausible actions the nation can take to slow this rise and keep health expenditures from consuming an ever greater portion of U.S. economic output. While health care services are essential to heath, there is growing recognition that social determinants of health are important influences on population health. Supporting this idea are estimates that while health care accounts for some 10 to 20 percent of the determinants of health, socioeconomic factors and factors related to the physical environment are estimated to account for up to 50 percent of the determinants of health. Challenges related to the social determinants of health at the individual level include housing insecurity and poor housing quality, food insecurity, limitations in access to transportation, and lack of social support. These social needs affect access to care and health care utilization as well as health outcomes. Health care systems have begun exploring ways to address non-medical, health-related social needs as a way to reduce health care costs.

To explore the potential effect of addressing non-medical health-related social needs on improving population health and reducing health care spending in a value-driven health care delivery system, the National Academies of Science, Engineering, and Medicine held a full-day public workshop titled Investing in Interventions that Address Non-Medical, Health-Related Social Needs on April 26, 2019, in Washington, DC. The objectives of the workshop were to explore effective practices and the supporting evidence base for addressing the non-medical health-related social needs of individuals, such as housing and food insecurities; review assessments of return on investment (ROI) for payers, healthy systems, and communities; and identify gaps and opportunities for research and steps that could help to further the understanding of the ROI on addressing non-medical health-related social needs. This publication summarizes the presentations and discussions from the workshop.

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