The United States spends more on health care per person than any other developed nation, but our health outcomes continue to lag behind. This is partly because we are failing to properly address the social, economic and environmental factors that influence individual and community health.
We know that issues like housing instability, social isolation and food insecurity lead to health problems. Children who live in areas with higher rates of unaffordable housing, for example, tend to have poorer health, more behavioral problems and lower school performance. Lonely seniors may be twice as likely to develop the type of dementia linked to Alzheimer's disease. And income and geography impact a family's ability to purchase nutritious food, leading to preventable diseases like diabetes.
Community-based human services organizations have been managing these social determinants of health for more than a century. Contracting with governments, these nonprofits care for children, the elderly and the disabled of all socioeconomic and cultural backgrounds. They deliver services and supports for immigrants, people with substance-use disorders, those experiencing homelessness, individuals caught up in the justice system, people with barriers to employment, and socially marginalized groups.
Historically, however, the health care system has operated in its own silo, isolated from the human services system of care. In some ways, health and human services are strangers living next door, working in close proximity but missing opportunities to complement and strengthen each other's work.
But we can look to New York as it tries to change this dynamic. The state is attempting to improve individual and community health through a transition to a value-based care system that rewards positive outcomes -- or value -- rather than the volume of services provided. A critical component of this effort is its goal of linking traditional health care services to the community-based human services system as a way to leverage the expertise of organizations well versed in addressing social determinants of health.
Value-based care systems are designed to provide better care and better outcomes while also lowering the cost of health care by preventing avoidable health issues. This person-centered model is an admirable goal, but it requires a true partnership with the trusted and seasoned entities providing human services in communities.
Recognizing both the challenges and opportunities of integrating these two systems, the Human Services Council of New York convened a group of leaders with experience and expertise spanning government, health care, philanthropy, academia and human services to examine and inform the state's health care reform efforts through a human services lens. The findings and recommendations were published in a report, "Integrating Health and Human Services: a Blueprint for Partnership and Action."
The report examines the paradigm shift from volume-driven to value-driven care from a practical perspective; appreciating the operating realities that community-based human services organizations face as a result of government contracting conditions, and it calls on government to take decisive action to strengthen these organizations, modernize the regulatory framework within which they operate, and foster cross-sector partnerships that truly incentivize positive outcomes.
Longstanding government policies, practices and funding patterns have undermined the fiscal health of the nonprofit human services sector. Many of these organizations have little or no reserves, and a significant number of them are insolvent, which severely limits their ability to take on risk. Addressing the challenges of financial uncertainty and low tolerance for risk will enable these organizations to collaborate more effectively with the health care system in value-based payment arrangements.
Health care reform is at a critical moment. The health care system, with its focus on episodic treatment, needs to be intentionally linked with the interventions provided by nonprofit human services organizations. We must ensure that all sectors -- government, health care, human services and even philanthropy -- work together to move the system toward greater integration.