Services 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), review the cost-lowering claims, and discuss the rising prevalence of HRSN services in government value-based care programs.
A Holistic Approach to Care
The US healthcare industry is increasingly accepting of the fact most chronic diseases have roots in behavioral and social factors. 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 Innovation in Behavioral Health (IBH) model. This program requires providers to screen for and address HRSNs as part of the program structure of care management, care integration, and health equity.
While many are familiar with SDOH—the conditions in which people are born, grow, work, live, and 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, like the CDC, have attempted to address them). HRSNs, however, are thought to be addressable by healthcare entities, and 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 delivery of nonclinical services to address HRSNs within healthcare is still in the developing stage. This may change rapidly, however, as a number of studies have shown that addressing HRSNs reduces overall healthcare costs for payers.
HRSNs Proven to Lower Cost of Care
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.
Based on an aggregate review of HRSN interventions completed by the Commonwealth Fund (CWF), addressing six HRSNs—housing, nutrition, transportation, home modification, care management, and 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, and their review found that housing, nutrition, and care management result in the greatest ROI.
- Housing: Providing housing options—specifically for homeless or elderly individuals—reduced high-cost care such as ED visits, hospital admissions, SNF, and LTC stays. These studies estimated the ROI for providing housing for such individuals could result in over $2,000 per person per month in savings, or $1.57 savings for every $1 spent.
- Care Management: Care management models utilizing community health workers to connect at-risk or high-risk patients to medical and nonmedical care resulted in an estimated $2.92 in savings for every $1 spent.
- Nutrition: Delivering medically tailored meals to beneficiaries with chronic conditions and nutritional risk is estimated to reduce overall healthcare costs by $220 per participant.
Government Programs Pioneer HRSN Service Delivery
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 delivery into value-based care programs. As with many innovative models, government programs have a history of incubating new methodologies, and as HRSN services become an accepted and expected part of the Medicare and Medicaid service offering, private payers may begin to follow suit.
Recent examples of government programs defining implementation plans and specific services to address HRSNs include CMS’s IBH program, North Carolina’s Healthy Opportunities Pilot (HOP) program, and New York’s 1115 Demonstration Waiver.
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 delivery will continue to evolve over the coming years, and 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.
Read More:
CMS Is Advancing Integrated Behavioral Health. Will Commercial Payers Follow?
About ECG
ECG Management Consultants is experienced in navigating the complex payer environments of physical and behavioral health payer contracting.
For assistance with behavioral health integration, government or value-based contracting, contact our experts in the Payer Strategy and Contracting Division.
Editor: Matt Maslin
Published May 17, 2024
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