Transportation, housing, and food insecurity are cited as patients' most common nonmedical needs.
Research published in the journal Health Affairs indicates that accountable care organizations are well-suited to help patients meet nonmedical needs associated with significant medical and financial consequences.
Transportation, housing, and food insecurity were the most common nonmedical needs tackled at the 32 ACOs involved in the study, which was based on executive interviews and site visits.
"These needs were common among their patient populations, the needs affected how patients engaged in medical care, and the ACOs had the potential to address these needs," the authors wrote. The research was conducted in 2013 and 2014.
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The research paper cites several earlier studies that show nonmedical patient needs have a profound impact on service utilization, clinical outcomes and cost of care.
"Estimates suggest that 40% to 90% of health outcomes are attributable to social, behavioral, and economic factors," the researchers wrote.
ACOs appear to offer a unique opportunity for healthcare providers to address the nonmedical needs of their patients.
"Given the significant impact of nonmedical factors on health costs and patient outcomes, ACOs may address underlying nonmedical factors to control costs and improve quality," the paper stated.
"Furthermore, proponents of the ACO model hope that it will afford providers the flexibility and incentives necessary to address patients' needs, including nonmedical needs, through better coordination and integration of care."
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Half of the 32 ACOs in the study were attempting to meet nonmedical needs either through targeting individual patients or by establishing programs for broad populations of patients, researchers found.
The study includes a "typography" that organizes the efforts to address nonmedical needs into four categories. On one end of the spectrum, "fully integrated" services are provided across multiple organizations as well as across medical and nonmedical care programs in a coordinated fashion.
At the other end of the spectrum, "non-coordinated" approaches lack integration between multiple organizations as well as the delivery of services.
ACOs uses a variety of approaches to help patients meet nonmedical needs. An ACO's local geography, population density, and community infrastructure were key factors in addressing transportation needs.
"One ACO in an urban area with poor public transportation was considering developing a mobile device application that would allow patients to request transportation from local drivers, who would be paid by the ACO," they wrote.
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ACO leaders said they drew on internal and external resources in their nonmedical need efforts.
"Internal resources often included staff members in existing team-based care management programs, with specific care teams assigned to assist patients with nonmedical needs… ACOs also used external resources such as community partners and public health agencies to meet nonmedical needs."
The Health Affairs paper identified scalability as a primary challenge of ACO efforts to meet nonmedical needs. "ACO leaders described instances in which they observed a general need but were able to provide only individual solutions, not broader programs," the study authors wrote.
"ACOs may encounter several barriers to developing formalized programs to meet patients' needs—barriers including lack of adequate financial resources, limited staffing capacity, lack of expertise, and competing clinical priorities."