云顶集团 to address health-related social needs (HRSNs) have become a prominent feature of value-based care models in the government programs space due to their proven ability to lower the cost of medical and behavioral healthcare. As part of our ongoing Mental Health Awareness Month series, here we differentiate HRSNs from social determinants of health (SDOH), 审查降低成本的要求, discuss the rising prevalence of HRSN services in government value-based care programs.
全面的护理方法
The US healthcare industry is increasingly accepting of the fact most chronic diseases have 根源在于行为和社会因素. The integration of physical and behavioral healthcare has continued to gain momentum since the COVID-19 pandemic, signifying a shift away from traditional siloed care models that focus more on treating clinical symptoms than on the root cause of illness and disease. In 2024, CMS took the movement toward holistic healthcare a step further in its 行为健康(IBH)模式创新. This program requires providers to screen for and address HRSNs as part of the program structure of 护理管理, 保健集成, 健康公平.
虽然很多人都很熟悉 SDOH——人出生的条件, 成长, 工作, 生活, age—HRSN is an emerging concept that refers to the social and economic needs individuals experience that influence their ability to maintain health and well-being. SDOH are often thought to be out of scope for healthcare providers (though some tangential professionals and organizations, 就像 疾病预防控制中心，试图解决这些问题). HRSNs, 然而, are thought to be addressable by healthcare entities, programs specifically targeting HRSNs are emerging.
While conceptually most would agree that targeting HRSNs will produce positive improvements to individual and population health, the funding for and de生活ry of nonclinical services to address HRSNs within healthcare is still in the developing stage. 这种情况可能会迅速改变, 然而, as a number of studies have shown that addressing HRSNs reduces overall healthcare costs for payers.
HRSNs被证明可以降低医疗成本
The primary aim of HRSN services is to improve clinical outcomes by fostering social and environmental equity. But HRSN services can also reduce the overall cost of care, especially for people with chronic physical and behavioral health conditions.
基于对…的综合评价 HRSN干预 由联邦基金完成, 解决六个hrsn -住房问题, 营养, 运输, 家修改, 护理管理, counseling—all result in a positive return on investment (ROI) for healthcare entities. Most of the studies that CWF reviewed focused on Medicare or dual-eligible beneficiaries, 他们的审查发现，住房, 营养, 和关怀管理带来最大的投资回报率.
- 住房: Providing housing options—specifically for homeless or elderly individuals—reduced high-cost care such as ED visits, 住院, SNF, 和LTC. These studies estimated the ROI for providing housing for such individuals could result in over $2,每人每月的储蓄, or $1.每花1美元就能节省57美元.
- 护理管理: Care management models utilizing community health 工作ers to connect at-risk or high-risk patients to medical and nonmedical care resulted in an estimated $2.每花1美元就能省下92美元.
- 营养: De生活ring medically tailored meals to beneficiaries with chronic conditions and 营养al risk is estimated to reduce overall healthcare costs by $220 per participant.
Government Programs Pioneer HRSN Service De生活ry
Given that lower-income and older adults are at greater risk of having HRSNs, it is unsurprising that government programs—Medicaid and Medicare—have pioneered early efforts to integrate HRSN service de生活ry into value-based care programs. 与许多创新模式一样, government programs have a history of incubating new methodologies, as HRSN services become an accepted and expected part of the Medicare and Medicaid service offering, 私人支付者可能开始效仿.
Recent examples of government programs defining implementation plans and specific services to address HRSNs include CMS’s IBH程序北卡罗来纳州的 健康机会试点(HOP)计划, 纽约1115示范弃权.
As the healthcare industry continues to look for ways to improve health outcomes while controlling costs, HRSN services are likely to become a permanent fixture in population health strategy, as well as a key element in innovative value-based care programs in the Medicare and Medicaid space. The financial structure to support HRSN service de生活ry will continue to evolve over the coming years, behavioral health providers serving the Medicare and Medicaid populations can position themselves as leaders in community health by integrating HRSN screening and service planning into their practice.
阅读更多:
Beneath the Surface of 行为健康 Parity: Implications for Provider Net工作 Management and Reimbursement
对心电图
心电图 Management Consultants is experienced in navigating the complex payer environments of physical and behavioral health payer contracting.
For assistance with behavioral health integration, 政府或基于价值的合同, contact our experts in the 付款人的策略 and 承包 Division.
编辑:Matt Maslin
出版于2024年5月17日
