< Back to Publications & Resources
New York’s Blueprint for Healthcare: The Rise of Social Care Networks – Part 2
By Salvatore Volpe, M.D., FACS, FAAP, FACP, FHIMSS, ABP-CI, CHCQM
What Role do Healthcare Providers Play in Confirming Eligibility
Health care providers may support members in accessing enhanced HRSN services by helping confirm eligibility when requested by Social Care Navigators. A Social Care Navigator may request provider attestation in certain situations, such as when eligibility criteria are not available in the member’s MCO data. The attestation then allows the member to be deemed eligible and receive enhanced HRSN services.
Providers may be asked to attest to the presence of specific clinical criteria (e.g., diagnosis of chronic conditions including mental health diagnoses and substance use disorder, pregnancy or postpartum status, children’s risk of malnutrition or history of low birth weight, etc.).
A completed provider attestation form can be used for members to be eligible for services such as but not limited to:
- Medically necessary home modifications such as ramps, handrails, grab bars, etc.
- Air conditioners, heaters, humidifiers and filtration systems.
- Refrigeration for prescribed medication for management of a chronic condition.
- Asthma remediation.
- Medical respite such as recuperative care pre- or post-hospitalization.
Considerations Physicians May Face When Integrating SCN Into Their Practice
Physicians should treat the SCN team the same way they would treat other traditional members of a care team. Clinicians should consider the SCN resources as options in the management of their patients.
For example, in addition to prescribing medications and recommending lifestyle changes for patients with diabetes, hypertension and congestive heart failure a consideration might be made to see if the member might benefit from enhanced services such as
- Nutritional counseling and education
- Medically tailored meals
- Food prescriptions
- Fresh produce and non-perishables groceries
- Cooking supplies (pots, pans, etc.)
Patients with chronic asthma might benefit from asthma remediation services such as:
- Asthma self-management education.
- Home remediation (e.g., mold or pest remediation).
- Air conditioners.
- Protective bedding covers.
- Vacuum with HEPA filter and filter replacements.
A challenge faced by some practices is related to the performance of the HRSN survey.
While practices could provide contact information for their patients to use to contact the local SCN, many are choosing to perform the survey themselves. Unfortunately, some EHRs do not have the required 13 questions loaded and formatted to submit to the health information exchange. Fortunately, many of the SCNs and HIEs have online platforms capable of performing the survey and providing the results for results in a format that can be read by the clinicians in their EHRs.
The Future of SCNs in New York
I believe that if we are successful, we will finally show not just the medical benefit in health outcomes and improved quality of life but also the financial impact.
How many families could we educate to better manage their children’s asthma if we avoid one admission?
How many groceries, meals and healthy food preparation/shopping classes could we provide if avoid one CHF, DKA or MI admission?
How many lost days of employment could be saved not just in the case of the patient but of the parent or other care giver?
Historically, the US has focused on acute care and yet has outcomes related to lifespan and maternal/child mortality that is significantly worse than many other countries with fewer resources.
This holistic approach moves the interventions literally before birth in some cases and by improving the quality of life of patients will no doubt enhance the patient-physician relationship.
Hopefully, these interventions will be expanded to all, independent of their type of insurance.
Follow us on Facebook, LinkedIn, Instagram or Twitter to stay in the loop about the medical professional liability industry.
If you are not already a MLMIC insured, learn more about us here.
This document is for general purposes only and should not be construed as medical or legal advice. This document is not comprehensive and does not cover all possible factual circumstances. Because the facts applicable to your situation may vary, or the laws applicable in your jurisdiction may differ, please contact your attorney or other professional advisors for any questions related to legal, medical or professional obligations, the applicable state or federal laws or other professional questions.
Sources:
https://odphp.health.gov/healthypeople/priority-areas/social-determinants-health
https://www.health.ny.gov/health_care/medicaid/redesign/sdh/scn/docs/intro_hcp_guide.pdf
https://www.health.ny.gov/health_care/medicaid/redesign/med_waiver_1115/hrsn/docs/protocol.pdf
