INVESTING IN INTERVENTIONS
THAT ADDRESS NON-MEDICAL,
HEALTH-RELATED SOCIAL NEEDS
PROCEEDINGS OF A WORKSHOP
Rose Marie Martinez and Joe Alper, Rapporteurs
Board on Population Health and Public Health Practice
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Health. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-49647-6
International Standard Book Number-10: 0-309-49647-0
Digital Object Identifier: https://doi.org/10.17226/25544
Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.
Copyright 2019 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
Suggested citation: 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. https://doi.org/10.17226/25544.
The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.
The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president.
The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.
The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.
Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.
Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.
Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.
For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.
PLANNING COMMITTEE FOR A WORKSHOP ON INVESTING IN INTERVENTIONS THAT ADDRESS NON-MEDICAL, HEALTH-RELATED SOCIAL NEEDS1
DANIEL E. POLSKY (Chair), Bloomberg Distinguished Professor of Health Policy and Economics, Carey School of Business and Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University
JOHN AUERBACH, President and Chief Executive Officer, Trust for America’s Health
SETH A. BERKOWITZ, Assistant Professor of Medicine, Division of General Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina at Chapel Hill
DAVE A. CHOKSHI, Chief Population Health Officer, New York Health + Hospitals Corporation
DEIDRA CREWS, Associate Professor of Medicine, Department of Medicine, School of Medicine, Johns Hopkins University
KAREN B. DeSALVO, Professor of Medicine, Dell Medical School, The University of Texas at Austin
ARVIN GARG, Associate Professor of Pediatrics, School of Medicine, Boston University
MAURICE JONES, President and Chief Executive Officer, Local Initiatives Support Corporation
Project Staff
ROSE MARIE MARTINEZ, Director, Board on Population Health and Public Health Practice
ANNA MARTIN, Administrative Assistant
Consultant
JOE ALPER, Consulting Writer
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
This page intentionally left blank.
Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by HARRY J. HEIMAN, Georgia State University. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
This page intentionally left blank.
Acknowledgments
The National Academies of Sciences, Engineering, and Medicine wishes to express its sincere gratitude to Daniel Polsky, planning committee chair, for his valuable contributions to the development and orchestration of this workshop and to the members of the planning committee who collaborated to ensure a workshop complete with informative presentations and rich discussions. Finally, many thanks to the speakers and moderators, who generously shared their expertise and their time with workshop participants, and the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Health for its support of this workshop.
This page intentionally left blank.
Contents
Organization of the Proceedings
Two Different But Complementary Meanings
Addressing Health-Related Social Needs at New York City Health + Hospitals
Moving Health Care Upstream in Massachusetts
Accelerating Investments for Healthy Communities
Medicaid Accountable Care Organization
Healthy Neighborhoods Healthy Families
Solving America’s Housing Crisis Requires All Hands on Deck
4 INTERVENTIONS ADDRESSING FOOD INSECURITY
Food Insecurity and Health: Consequences and Interventions
A National Vision to Improve Diabetes Health Outcomes Using Food as Medicine
A Bold Goal: Improving Health by Addressing Food Insecurity
Feeding America: Interventions Addressing Food Insecurity
5 INTERVENTIONS ADDRESSING MULTIPLE SOCIAL NEEDS
IMPaCT: A Standardized, Scalable Community Health Worker Program
Community Aging in Place—Advancing Better Living for Elders (CAPABLE)
Addressing Social Determinants of Health Through Medical–Legal Partnerships
CommunityRx: Connecting Health Care to Self-Care
Assessing the Value of the Social Determinants of Health
Return on Investment at the Centers for Medicare & Medicaid Services
Beyond the Return on Investment
A Research Agenda for Health Care Activities Related to Improving Social Care and Social Conditions
Box, Figures, and Tables
BOX
2-1 Population-wide Policy Resources Exist to Address Social Determinants of Health
FIGURES
2-1 The many factors that play a role in determining an individual’s health outcomes
2-2 Inequalities in life expectancy across counties are large and increasing over time
3-1 Health systems invest in a range of housing types
3-2 Cross-sector utilization by a Medicaid expansion population
3-3 A capital stack structure for improving affordable rental properties
4-1 How addressing the social determinants of health can improve health
5-1 What patients believe will help them improve their health
Acronyms and Abbreviations
ACO | accountable care organization |
CAPABLE | Community Aging in Place—Advancing Better Living for Elders |
CDC | Centers for Disease Control and Prevention |
CMMI | Center for Medicare & Medicaid Innovation |
CMS | Centers for Medicare & Medicaid Services |
DoN | determination of need |
ED | emergency department |
EHR | electronic health record |
HHS | U.S. Department of Health and Human Services |
HIPAA | Health Insurance Portability and Accountability Act |
HUD | U.S. Department of Housing and Urban Development |
IMPaCT | Individualized Management for Patient-Centered Targets |
NCH | Nationwide Children’s Hospital |
NIH | National Institutes of Health |
OECD | Organisation for Economic Co-operation and Development |
ROI | return on investment |
SIREN | Social Interventions Research & Evaluation Network |
SNAP | Supplemental Nutrition Assistance Program |
UCSF | University of California, San Francisco |
USDA | U.S. Department of Agriculture |
VA | U.S. Department of Veterans Affairs |
WIC | Special Supplemental Nutrition Program for Women, Infants, and Children |