Cockerell, Tray

Dobbins, Jess

Nash, David B.

Woodard, LeChauncy

Jefferson Digital Commons

Thomas Jefferson University Jefferson Digital Commons College of Population Health Faculty Papers Jefferson College of Population Health 4-9-2021 Multi-Sector Partnerships and Networks to Support Social Health, Medical Education, and Return on Investment. David B. Nash Thomas Jefferson University Jess Dobbins Humana, Inc. Tray Cockerell Humana, Inc. LeChauncy Woodard University of Houston; Michael E. DeBakey VA Medical Center Follow this and additional works at: https://jdc.jefferson.edu/healthpolicyfaculty  Part of the Medical Education Commons, and the Public Health Commons Let us know how access to this document benefits you Recommended Citation Nash, David B.; Dobbins, Jess; Cockerell, Tray; and Woodard, LeChauncy, "Multi-Sector Partnerships and Networks to Support Social Health, Medical Education, and Return on Investment." (2021). College of Population Health Faculty Papers. Paper 122. https://jdc.jefferson.edu/healthpolicyfaculty/122 This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in College of Population Health Faculty Papers by an authorized administrator of the Jefferson Digital Commons. For more information, please contact: JeffersonDigitalCommons@jefferson.edu.  1  Point of View Multi-sector Partnerships and Networks to Support Social Health, Medical Education, and Return on Investment  David B. Nash, MD, MBA Jefferson College of Population Health, 901 Walnut Street, 10th Floor, Philadelphia, PA  19107 (215) 955-6969 david.nash@jefferson.edu  Jess Dobbins, DrPH, MA (Corresponding author)  Humana Inc., Office of Health Affairs and Advocacy, 500 W Main St, Louisville, KY 40202 (360) 271-9261 jdobbins@humana.com  Tray Cockerell, MA, SPHR Humana Inc., Office of Health Affairs and Advocacy, 500 W Main St, Louisville, KY 40202 (502) 580-5027 tcockerell@humana.com  LeChauncy Woodard, MD, MPH University of Houston, College of Medicine, 6014 Health 2 Building, Houston, TX 77204; and Houston Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX (713) 743-0875 lwoodard@central.uh.edu  Running title: Multi-sector Partnerships and Social Health Keywords: multi-sector partnerships, social determinants of health, medical education, social needs, social risk factors, return on investment  2  Author Disclosure Statement Aside from their employment, the authors declare that there are no conflicts of interest.   Funding No funding was received for this article.                          3  Introduction  There is no doubt that social context contributes to overall health and wellness. Every human being has social needs, and meeting those needs may be the turning point in creating better outcomes for many patients. Access to basic physiological and safety needs such as food and affordable housing are known barriers to health and well-being.1-3   The relationship between social needs and health is fairly well documented and gaining national recognition as a gap in patient care. Yet, the financial benefit of supporting social health has yet to be fully recognized. To address these issues, disparate sectors of the health ecosystem are beginning to come together in new ways to address these gaps. For example, in an innovative approach to move efforts upstream the University of Houston and Humana, a national health and well-being company, have established the Humana Integrated Health System Sciences Institute to advance the next generation of health professionals’ education through interdisciplinary training with a focus on improving population health outcomes and expanded use of value-based payment models.   Building on this collaboration, we engaged thought leaders from a variety of Houston health and allied health sectors (eg, academia, industry, government, philanthropy, primary care) and disciplines (eg, business, finance, medicine, policy, public health, social work) to identify collaborative strategies to address social determinants of health.  This diverse group came together to participate in a TEDMED curated Jeffersonian style dinner discussion to share successes and challenges of addressing health-related social needs and to build a sense of cohesion and synergy around shared efforts to improve the overall health of the community.   The dinner discussion centered on the following prompt: “Please tell us about a time that you successfully, or unsuccessfully, engaged in a nontraditional partnership or collaboration to address a significant health issue.” Guests shared their responses and identified common themes during the dinner discussion. Three key themes emerged:  4  1. Improving health depends on more than improving medical care. Social risk factors and health-related social needs also must be considered.  2. Medical education needs rethinking. Curricula should include social determinants of health, and aspiring practitioners need to work in interdisciplinary teams during their training.  3. A strong financial case for addressing social needs in health care has not been made. Overcoming social barriers to health should result in a healthier population with a focus on proactive, preventive health care strategies, but the return on those investments is not entirely clear.   Improving health depends on more than improving medical care   One participating health leader explained that it was not uncommon to hear patients say things like, “My grandmother died from diabetes. My mother just lost her foot to diabetes. There is nothing I can do – I know I’m going to get diabetes.”  Beliefs about current and future health, and level of health knowledge, likely will modify the degree to which individuals engage in their health care and management,4 and are important considerations for care teams supporting their patients’ complex health needs.   Addressing social determinants of health, social risk factors, and social needs is important to improve health and reduce health disparities,5-7 but will require participation from stakeholders across the health ecosystem.   Clinicians, researchers, payers, and policy makers acknowledge the relationship between biological, psychological, social, environmental, and behavioral domains in constituting risk and producing better health.8 Comprehensive health care delivery models, such as the patient-centered medical home and others, offer the interdisciplinary framework to support the myriad factors that influence patients’ health. It is critical that our data systems support the evolution of our care models. There is a real need to look beyond medical care and claims data and  5  leverage individual- and population-level data related to nonclinical factors (eg, housing stability, food access, loneliness and social isolation, health literacy, patient values and beliefs) to inform our care and decision making.   Medical education needs rethinking  Medical, and other health professional, education also needs to keep pace with evolving patient needs and health care models. There is tremendous value in experiential learning for students – beyond residency training – out in the community where learners can observe, appreciate, and participate in the complex biological, psychological, social, and environmental factors affecting health.  Dinner guests reflected on existing innovative clinical training programs,9,10 and the ways in which their own nontraditional training experiences (eg, working with homeless populations, serving as health educators) have made them better clinicians.   Interdisciplinary collaboration is the future of health care. As the industry shifts from fee for service to value-based payment, interdisciplinary collaboration becomes essential. The relationship between physical and mental health indicates the obvious need for interdisciplinary treatment planning and care coordination; chronic conditions cannot be managed independently from depression, substance abuse, or other mental and behavioral health conditions.  Similar relationships extend to social and environmental health domains. It is essential that clinicians and practitioners from these disciplines coordinate and collaborate effectively. The skills and competencies required to be successful in value-based care and payment models require a great deal of practice, and necessitate interdisciplinary education and training.   A strong financial case for addressing social needs in health care has not been made  Attending to patients’ nonmedical needs (eg, transportation, food access, social support) can improve health outcomes and reduce inappropriate use of health care services, but there is a  6  paucity of research describing the return on investment (ROI) for addressing such health-related social needs.11   However, the importance of addressing such needs is gaining momentum as health systems seek to identify sustainable payment models to address the needs of high-complexity patients. These patients most likely will benefit from comprehensive, patient-centered care with attention to social determinants of health such as food insecurity, housing, and transportation.12   There are some known and perceived risks of investing in social needs. Patients often change health plans or providers, or their eligibility for certain plans changes before the benefit of the investment is fully realized.  Assuming there is an ROI, who recoups the cost and when?  There is a good chance that the primary beneficiary is not the investor. It is sometimes unclear how to ensure the appropriate provision of social services and support outside of the traditional health care system.  Many of the proposed social health care models require interoperable data and technology platforms and cross-sector collaborations to ensure coordinated care across the broader health ecosystem. As we think through these complexities, it becomes clear that the ROI in social health cannot be fully appreciated within the silo of a single discipline.     Conclusion  Supporting social health, advancing medical education, and realizing an ROI in health-related social needs will require nontraditional partnerships and collaboration across the health ecosystem.  Community discussions, such as our curated dinner, are an important step in opening the dialogue and developing the multi-sector partnerships and networks needed to support population health.      7  Correspondence should be directed to Jessica Dobbins at 500 W Main St. Louisville, KY 40202                               8  References  1. Adler NE, Cutler DM, Fielding JE, et al.  Addressing Social Determinants of Health and Health Disparities: A Vital Direction for Health and Health Care. Washington, DC: National Academy of Medicine; 2016. doi: 10.31478/201609t 2. Galea S, Tracy M, Hoggatt KJ, Dimaggio C, Karpati A. Estimated deaths attributable to social factors in the United States. Am J Public Health. 2011;101:1456-1465. 3. Healthy People 2020. Social Determinants of Health. 2020. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health. Accessed March 6, 2020. 4. Rosenstock IM, Strecher V, Becker J. Social learning theory and the health belief model. Health Educ Q. 1988;15:175-183. 5. Braveman P, Egerter S, Williams DR. The social determinants of health: coming of age. Annu Rev Public Health. 2011;32:381-398. 6. Taylor LA, Tan AX, Coyle CE et al. Leveraging the social determinants of health: What works? PLoS One. 2016;11(8):e0160217. 7. Artiga S, Hinton E. Beyond health care: the role of social determinants in promoting health and health equity. 2018. http://files.kff.org/attachment/issue-brief-beyond-health-care. Accessed March 7, 2020.  8. Agrawal SK, Shrank WL. Clinical and social risk adjustment – reconsidering distinctions. N Engl J Med. 2020;382:1581-1583.  9. Children’s Hospital, St. Louis. Inter-Professional Residency Program. 2020. https://www.stlouischildrens.org/healthcare-professionals/nurses/inter-professional-residency-program. Accessed April 21, 2020. 10. Department of Veterans Affairs. VA’s Centers of Excellence in Primary Care Education. 2019. https://www.va.gov/OAA/docs/CoEPCE_Scholarly_Works.pdf. Accessed April 21, 2020. 11. Nichols L, Taylor L.  Social determinants as public goods: a new approach to financing key investments in healthy communities. Health Aff. 2018;37:1223-1230.  9  12. The Commonwealth Fund. Return on Investment (ROI) Calculator for Partnerships to Address the Social Determinants of Health. 2020. https://www.commonwealthfund.org/roi-calculator. Accessed April 21, 2020.   

Multi-Sector Partnerships and Networks to Support Social Health, Medical Education, and Return on Investment.

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Multi-Sector Partnerships and Networks to Support Social Health, Medical Education, and Return on Investment.

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