Upstream With a Small Paddle: How ACOs Are Working Against the Current to Meet Patients’ Social Needs

Genevra F. Murray
Hector P. Rodriguez
Valerie A. Lewis
Peer-Reviewed Article
March 2020

While accountable care organizations (ACOs) offer promise for integrating social services into medical care, ACOs report significant barriers to successful integration. Using qualitative data from 22 diverse early-adopter ACOs, this study examines three main challenges to integration faced by ACOs: funding, data collection, and community partnerships.

The most common barrier to success for ACOs is a lack of clear funding mechanisms and incentives. ACOs in this sample reported difficulties identifying fiscal resources to promote long-term sustainability, challenges in determining how to prioritize use of existing funds, and uncertainties around calculating return on investment for program evaluation. ACOs also highlighted problems with data tracking and sharing. Only half of the ACOs analyzed had standardized screening for social needs of their patients, and most of them lacked infrastructure for internal tracking of patient social needs data. Establishing partnerships with community-based organizations (CBOs) was another challenge. While almost all of the ACOs referred patients to CBOs for necessary social services as opposed to directly providing these services, ACOs had limited relationships with local CBOs. Many of them also did not have data on CBOs to inform potential partnerships and, when programs were developed with CBOs, few shared data with one another.

Recommendations suggested by the authors to facilitate successful integration include sustainable funding, networking initiatives to connect local health care and social service organizations, and online referral systems with accurate data on local CBOs to inform health care providers of available services.

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