As we continue to focus on value-based care, with particular attention being put on the social needs of those we serve, how these investments are made is important. Historically, funding for this was part of the public health sector, either by governmental or philanthropic funding. However, as we move towards value-based payment models, other delivery entities begin to recognize the value in investing in social determinants.
Up until recently, there has been minimal understanding of how 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 essential. It is a new source of dollars for those that are providing services. More importantly, it shows the interest in expanding our thinking beyond the four walls of a hospital as well as allowing for improved coordination between institutions.
In a recent article in Health Affairs by Horwitz et al., they discovered that by searching public announcements involving direct investments, they identified 78 such activities between 2017 and 2019. Additionally, this discovery included 917 hospitals and comprised of $2.5 billion in healthcare funds. The majority of these dollars went to housing-focused interventions. Thus, these findings attest to the increasing investments occurring in areas where the need is identified.
Furthermore, Health systems have the ability not only to invest financial resources, but they can also contribute in many other ways. By coordinating information and sharing their data they can enhance the impact their information can offer. More importantly, there is an ability to grow those entities that might have a more significant effect. Since the social safety net has historically been a patchwork of activity by the extremely well-intended, this latter component might lead to certain entities combining their resources or they may even cease to exist.
Many will view this effect unfavorably; however, stepping back requires us to analyze the problem we are trying to solve critically. It’s essential to realize that with limited resources, a surgical focus will need us to be discerning with our funds. Do I spread my dollars broadly, or do I invest them? Since integration is paramount for improvement, let us not avoid this duality and, instead, address it head-on. Let us not only continue to evolve our viewpoint on the best utilization of how the money is spent but also support those entities that will have the greatest impact. Only through diligence will we obtain the results we all seek, a healthier society in which both individuals and communities thrive.