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“I thought YOU asked!”: Understanding the Division of HCP Responsibilities in Assessing Patient Social Needs

Anupriya Nagarathnam

Post By Anupriya Nagarathnam

May 19, 2017

As the Centers for Medicare & Medicaid Services invest in models for more impactful redistribution of resources, health care providers and payer organizations are focusing on alleviating health-related social needs that drive up costs.

InCrowd wanted to explore what health care providers think about this social needs assessment-based approach, and who they view as key stakeholders. Using our microsurvey technology, we reached out to 150 healthcare professionals (HCPs, nurses, physicians, NPs, and PAs) to get their thoughts on how social needs assessments actually play out.  

What is a Social Needs Assessment

Health-related social needs are circumstances that influence a patient’s ability to maintain or improve their overall health. This includes factors like housing, employment status, access to transportation, food insecurity, and ability to pay non-medical bills.

A social needs assessment is any time spent discussing these issues, and can range in format from conversations with an HCP or clinic staff member to a questionnaire as part of a patient’s intake paperwork.

Who Conducts Assessments

The majority of our survey respondents said that social workers should be responsible for assessing patients’ health-related social needs (75%)*. Primary Caregivers (PCPs/NPs/PAs) came out as the second most likely to be accountable for this work (64%).

Interestingly, a majority of respondents—especially physicians—said that patients should be responsible for assessing their own needs (61%).

Using Assessments

Our research found a discrepancy between simply “factoring in” or accounting for health-related social needs when creating their patient’s treatment plan, versus spending time talking to patients about how these unmet needs were impacting their overall health and adherence to treatment.

  • 80% of practitioners in every subgroup reported factoring in social needs sometimes or always.  
  • Only 53% however reported actually asking their patients about these needs every time or most times during a visit
  • Nurses (63%) and Nurse Practitioners (68%) were most likely to ask patients about social needs.

Less than half of doctors (39%) said they did, unsurprisingly citing limited time available per patient and lack of insurance reimbursement for such work as the main reasons.

Navigating After the Assessment

Once needs have been linked to treatment and medication plans, there is a complex network patients must navigate to access services and resources that will allow the assessment-based plans to have full impact.

For example, submitting utility shutoff protection paperwork, looking up transportation options to and from appointments, or finding the locations of local food banks.

Survey respondents identified social workers (65%), nurses (61%), and primary caregivers (58%) as the most common resource navigators for patients. A majority of respondents—especially physicians—also said that patients should be responsible for navigating the resource landscape themselves (58%).

In line with existing research, however, access to social workers is largely dependent on an HCP’s  practice setting.

  • 90% of HCPs in academic hospitals and 70% in community hospitals reported having access to on-site, full or part time social workers.
  • Just 30% of office-based HCPs reported any level of on-site social work access.
  • Only 15% said they have access to an off-site social worker.
  • Nearly a fifth (18%) of office-based HCPs report they currently have no access to such resources for their patients.

Office-based HCPs also reported lower current levels of other social needs resources, like non-clinical patient advocates, volunteer-based clinical support programs, and/or case managers.

Our survey reveals that roles and responsibilities for conducting health-related social needs assessments and providing resource navigation remain unclear, and that access is highly dependent on practice facilities.

Yet, HCPs appear to demonstrate a strong awareness of this approach and are, at the very least, factoring it into treatment plans.

 

*Where not otherwise noted, percentages in body reflect total responses from all respondents.  Images reflect breakdown by health care profession.

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