Financial Sustainability for Complex Care Models Serving Low-Income Patients: a New Role for Philanthropy

Sherman, Anne; Rossides, Alexander; Cantor, Jeremy

doi:10.1007/s11606-022-07930-6

Cited by 1 publication

(2 citation statements)

References 6 publications

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“…Grant funding and contracts with local government agencies are often required to build, modify, and sustain robust models of integrated medical and social care. 34 Organizations need greater flexibility to support program costs. While many markets are shifting from fee-for-service to value-based payment and other alternative payment models, many of the newer payment models still constrain opportunities to sustain and scale integrated medical and social care.…”

Section: Payment Reformmentioning

confidence: 99%

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Integrated Interventions to Bridge Medical and Social Care for People Living with Diabetes

et al. 2023

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Social drivers of health impact health outcomes for patients with diabetes, and are areas of interest to health systems, researchers, and policymakers. To improve population health and health outcomes, organizations are integrating medical and social care, collaborating with community partners, and seeking sustainable financing with payors. We summarize promising examples of integrated medical and social care from the Merck Foundation Bridging the Gap: Reducing Disparities in Diabetes Care initiative. The initiative funded eight organizations to implement and evaluate integrated medical and social care models, aiming to build a value case for services that are traditionally not eligible for reimbursement (e.g., community health workers, food prescriptions, patient navigation). This article summarizes promising examples and future opportunities for integrated medical and social care across three themes: (1) primary care transformation (e.g., social risk stratification) and workforce capacity (e.g., lay health worker interventions), ( 2) addressing individual social needs and structural changes, and (3) payment reform. Integrated medical and social care that advances health equity requires a significant paradigm shift in healthcare financing and delivery.

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Section: Payment Reformmentioning

confidence: 99%

“…44 Medicare could expand billing codes with specific inclusion of other health care workers (e.g., nurses and social workers) to deliver billable services that are typically difficult to reimburse such as care coordination, patient assessment, and other preventive care. 7,34…”

Section: Payment Reformmentioning

confidence: 99%