The quest to contain health costs while improving the quality of care typically focuses on service delivery, such as reducing unnecessary or harmful medical procedures. But changes in health care financing are pushing some health systems to take a more holistic approach and address social factors that directly impact patients’ health. Think of it as the “community cure” for health care.
The rationale for thinking outside the clinical setting is compelling. According to a recent Robert Wood Johnson Foundation study, only 20 percent of the factors that influence a person’s health are related to access and quality of health care. The other 80 percent are due to socioeconomic, environmental, or behavioral factors –including unhealthy housing, poor diet, inadequate exercise, and drug and alcohol use. As federal and state reforms prod payers to move away from traditional fee-for-service—which pays for volume, not outcomes—and toward a pay-for-performance model that rewards keeping people healthy, the economic argument for addressing social determinants of health becomes clear.