It’s great that Connecticut hospitals are using technology to help busy providers connect patients with community services. Without basics like healthy food and safe shelter, patients can’t heal and healthcare costs rise.
But referrals are only the first step. The institutions on the other end of the referrals that provide those critical services in communities are straining. If this is going to work, the savings from the healthcare system must be re-invested in communities. But the incentives aren’t set up for that.
Most health outcomes have far more to do with what happens outside than inside healthcare practices and institutions. Robust community services can break the cycle for hospital patients with complex needs. When their condition is stabilized, they are discharged with important recommendations and referrals. But if they can’t access the resources they need to follow doctors’ orders, their health declines, and they end up back in the hospital.
A new study found that U.S. doctors are behind other high-income countries in coordinating care and connecting patients to community services. We need to do better.
In an attempt to address the problem, healthcare is moving to hold providers and health systems more accountable with financial penalties. That always makes large organizations pay attention. In response, hospitals and large health systems are reaching out to those community services that keep us well.
Unfortunately, in the U.S., the incentives go back to the large health systems, instead of addressing increased demand on food banks, shelters, employment programs, and affordable housing.
Making referrals easier for providers who have less and less time with patients is a good thing. The problem is that the capacity of communities to provide those things is fragile. When a provider refers a patient to a specialist, it is covered by the payer, either an insurer or a government program. But payment to cover a referral to a shelter or food program depends on the mosaic of community funders including private foundations, government grants, and charity.
To a person, directors of local food pantries, housing authorities, shelters, and local public health departments welcome anyone who needs their services, regardless of payment. They are among the most generous people I know and are happy they can help more people. But demand for their services is growing and revenues aren’t keeping up –- the “new normal.”
There is a solution. Robust community services help keep people healthy, reducing healthcare spending, especially for people with complex (read: expensive) conditions. At the same time, health systems are sharing in the savings generated when they connect patients to community services. Which is all great. But those dollars must in turn be shared with communities if we want to make any of this work.
Community services cannot rely on generosity and enlightened leadership at healthcare institutions. This is especially true as that leadership is increasingly for-profit and outside Connecticut. Some hospitals are doing this, but we need to make it part of our system’s design. Policymakers have to do the right thing and support community services that are keeping us healthy.
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