Evidence Supports the Connection Between Hospital Social Workers and Better Outcomes, Lower Costs
America’s approximately 170,000 medical social workers received conflicting news in recent weeks. A highly publicized study published in The New England Journal of Medicine in early January found that intensive “hotspotting” to address patients at risk from social determinants of health (SDoH) failed to lower healthcare costs. However, according to NPR reporting, other such SDoH initiatives have succeeded in reducing spending by five percent among “super utilizers” who can account for up to half of healthcare spending.
The mixed results have not deterred health many health policy experts on the concept of hotspotting.
“…to stop now would be foolish,” said Susan Cooper this week, Chief Integration Officer for Regional One Health (ROH), a Memphis-based health system that has achieved success with the reported Camden Model (named after Camden, NJ where the project was conducted) it launched in 2018. ROH has already documented $9 million in savings on 350 patients with unmet SDoH needs.
A SDoH Strategy is Indicated
So, which research is right? It turns out an argument can be made that both sets of findings support a SDoH, whole-person care strategy. Camden coalition staff and patients both report that despite SDoH spending on average $14,000 per patient that did achieve some individual success, “(SDoH) resources were often in short supply.”
There are other initiatives and insights to support social services contributions to more effective and lower-cost healthcare delivery. As early as 2003, when value-based healthcare delivery was just a gleam in the eye of policymakers, The Hospitalist cited the contribution of hospital social workers:
“Dr. Bradley Flansbaum, DO, MPH, a hospitalist and internist with the Division of Internal Medicine/Primary Care at Lenox Hill Hospital, Bronx, N.Y.… believes that hospitalists provide a unique history-taking perspective that is useful to social workers in their work. Foremost, social workers bring a rich understanding of the available resources that patients need after discharge and a view of the patient’s nonmedical circumstances. Together, the two professionals’ daily interactions generate more effective discharge planning as a part of the multidisciplinary team. Perhaps the area where the social worker most teaches the hospitalist regards available resources to solve problems over and above the purely medical (SDoH).”
Studies Support the Contribution of Hospital Social Workers
Since Dr. Flansbaum wrote those words in 2003, other studies have supported his insight.
Aurora Sinai Medical Center saved over $1 million, reducing ER visits over four months from 487 to 155 with just 39 targeted high-utilizers (the commonly used “frequent flier” label is now considered to be pejorative). A 2017 study published in Quality in Primary Care reported on Swedish rehabilitation hospital-based study that found 41 of 100 newly diagnosed patients with rheumatoid arthritis experienced psychosocial problems (SDoH). The researchers concluded that: “… social work in somatic healthcare is most successful in patients with sicknesses related to social and psychosocial problems.”
And in a third example, a case study published in Social Work Health Care around a large home-based primary care program at Mount Sinai in New York concluded that:
“Social workers at MSVD have a wide variety of roles, and many of these mirror the roles of social workers in other community based medical settings: they help patients cope with their complex chronic illness and proactively address problems that inhibit quality care, they provide counseling to help address depression and anxiety among patients and caregivers, and they support patients and families who are facing serious and often life-limiting illnesses.”
No doubt, further research will likely strengthen the SDoH/whole-person care tie between social service providers and medicine. A 2017 systematic review of social work/medicine studies published in the American Journal of Public Health found that “despite positive overall effects on outcomes,” differences in study methods and patient populations “render generalization difficult.” However, the study also stated that “most studies showed positive effects on health and service utilization; cost-savings were consistent across nearly all studies.”
Value-based Payments Best Supported with Improved Data Management Platforms
For the time being, the cost of social workers appears to more and more be absorbed in value-based reimbursement models. The current transition from fee-for-service (volume-based) to value-based (paying for good healthcare outcomes) requires that hospitals, for example, avoid costly 30-day readmission. Medicare has instituted payment penalties for such events. As delivery history has demonstrated private insurance payers trail Medicare once CMS, Medicare’s parent agency, demonstrates lower cost, higher quality delivery alternatives.
In the managed care arena, for example, payers rely heavily on social workers to deliver more efficient outcomes managing mental health patients. However, social workers in these environments report they are stressed with growing administrative burdens related to authorization, evidence-based treatment, and other documentation. Such was the topic of a 2018 Vice article about hospital social worker attrition. A social worker in a large healthcare system reported that for every hour she and her colleagues spend in face-to-face consultation with patients, they spend two hours completing paperwork. Such a situation is inefficient in a value-based world. Data technology platform solutions to relieve such operational stress is clearly in order.
Despite the challenges, research has demonstrated the contribution of hospital social workers. They ease the stress and cost of transitional care from the hospital back home and facilitate primary care follow-up to avoid readmissions. Social workers help relive SDOH risks related to food, housing, transportation, and prescription shortages, as well as facilitate communication in the entire provider chain. As demonstrated, these skills save delivery costs by keeping patients out of the emergency room and hospital via whole-person care. In short, hospital social workers – working with the tens of thousands of social agency social workers – provide an active link of humanity to comfort and reassure patients.