Even if doctors could prescribe lifestyle improvements for their patients—a safer home or healthier food—instead of pills and shots, they might not know where to begin.
As of Wednesday, however, clinical providers will have one more tool to help them determine what their patients need outside the doctor's office. A new screening toolkit compiled by the Boston-based not-for-profit Health Leads is geared toward providers who want to gauge patients' unmet social needs, laying out foundations and best practices for the challenging task of obtaining sensitive information in a simple, precise and accurate manner.
“There really hasn't been a lot of guidance for healthcare practitioners and institutions on how to actually address social needs in clinical settings.” said Rocco Perla, the president of Health Leads and a former senior official at the CMS. And unless vital social needs are fulfilled, medical interventions risk becoming futile. Compared to a safe, heated home, nutritious food or electricity, “all the healthcare in the world isn't going to be as helpful,” Perla said.
A growing contingent of healthcare experts, policymakers and providers is recognizing that addressing an individual's basic social needs could improve not just his or her health and the quality of care but also lower costs. But efforts to bridge that gap are still in their infancy, far from being standardized or widespread among practices.
In January, the CMS Innovation Center designated $157 million for a pilot project, part of the Accountable Health Community model, to test whether screening patients for and then addressing social needs would improve their health.
“We recognize that keeping people healthy is about more than what happens inside a doctor's office,” Health and Human Services Secretary Sylvia M. Burwell said at the time. “That's why, for the first time, we are testing whether screening patients for health-related social needs and connecting them to local community resources like housing and transportation to the doctor will ultimately improve their health and reduce the cost to taxpayers.”
But even the first step—screening patients effectively—can be a tall order. Low rates of literacy among patients, limited time in the doctor's office and the need to draw highly specific information from a condensed set of questions are all problems providers might face.
Health Leads' “Social Needs Screening Toolkit” is supposed to ease that process.
The guide is free and downloadable. It is based on clinically validated guidelines from the Institute of Medicine and CMS and offers sets of screening questions for fundamental social needs, like food or housing insecurity, transportation problems, exposure to violence, and optional ones, like employment or mental health, that providers can customize to fit their patients.
An ideal screening process, the guide says, “will begin to surface social needs by offering a tool that is easy to complete [and] questions that are simple for patients to understand.” The process will also be “integrated into clinical workflows with clear next steps upon completion.”
Screening questions must determine whether a patient actually wants help, the guide points out. It's the difference between asking “In the last 12 months, did you ever eat less than you felt you should because there wasn't enough money for food?” and “Would you like help getting healthy food for you or your family?”
In 2013 and 2014, researchers at Massachusetts General Hospital partnered with Health Leads to compare the health outcomes of patients with unmet needs and those without. Their findings, published in November 2015 in BMJ Quality and Safety, indicated that patients who could not afford medications, heating or food, or faced other social challenges had a greater prevalence of depression, diabetes and hypertension, although the researchers cautioned that their data were insufficient to serve as “evidence that the strategy of helping patients meet basic needs as part of routine care improves health.”
As awareness of the link between health outcomes and social needs spreads, screening patients is just one step in a long process of helping those who need it. Yet, it is a critical one; only after providers know that a patient can't pay her rent can they connect her with someone who can help.
“We think the entire healthcare system should be using it,” Perla said. “This should be a minimum standard of care.”