As we continue to focus on value-based care, with special attention put on the social needs of those we serve, how these investments occur becomes paramount. Historically, the buckets of allocated dollars for social needs lived in the public health sector, either by governmental or philanthropic funding. However, as we move towards value-based payment models, other delivery entities have begun to recognize the value in such activities.
Until recently, there has been minimal understanding of to what extent health care systems are directly investing in community programs that address social determinants of health. There are multiple reasons why this source of funding becomes crucial. Essentially, it is a new source of dollars for those that are providing services. Moreover, it indicates an interest in expanding our thinking beyond the four walls of a hospital and allows for optimum coordination between institutions.
A recent article in Health Affairs by Horwitz et al. finds that by searching public announcements from healthcare companies and organizations involving direct investments, they identified seventy-eight such activities between 2017 -2019. This finding included 917 hospitals and involved $2.5 billion in health care funds. Additionally, the majority of these dollars went to housing-focused interventions. These facts attest to ever-increasing investments in social factors, in addition to identifying where many believe the strongest need resides.
Health systems have the ability to not only invest financial resources, but they may lend support in a multiple of other ways. One being, coordination of information and sharing data, which means a greater impact can be made. More importantly, there is an ability to grow those entities that might have the most significant impact. As the social safety net has historically been a patchwork of activity by the well-intended, this latter component of healthcare organizations allocating direct spending to improve social outcomes might lead to certain entities combining their resources or they may cease to exist.
Many will view this effect negatively; however, stepping back requires us to analyze the problem we are attempting to solve. We must remember that with limited resources, a surgical focus will require discernment regarding funds. Hence, do I spread my dollars broadly, or do I delegate them towards a deeper investment? As integration is paramount for improvement, let us not avoid this duality and address it head-on. Let us not only continue to evaluate our views of optimal spending practices but also support those entities that will have the most significant impact. Only through diligence will we obtain the results we all seek which is a healthier society where both individuals and communities can thrive.