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Study Finds Nonmedical Social Services May Be the Answer to Improve American Health


Integrating nonmedical social services with medical services is necessary for the United States healthcare system to address unmet social needs, according to a case study published in Health Affairs.

Integrating nonmedical social services with medical services is necessary for the United States healthcare system to address unmet social needs, according to a case study published in Health Affairs.

In the United States, a vast representation of racial, ethnic, and socioeconomic backgrounds creates many different health outcomes that are the result of nonmedical issues. Yet almost no community care centers have adopted a screening procedure for patients that evaluate social needs, such as food and electricity.

According to a 2011 survey of 1000 primary care providers, 85% believed unmet social needs resulted in poor health. In addition, 80% of the survey participants felt they did not have the resources to address these unmet needs.

Health Leads, a social enterprise that connects healthcare institutions and communities to address patient’s basic resource needs, demonstrated 5 stages of diffusion—or the process of spreading an innovation in a community until the model is adopted—of an approach for including social needs into medical care.

Once community care centers adopted the Health Leads model, these institutions would incorporate at least one of the core elements of a high-quality social needs intervention program, including leadership and change management, the identification and screening of the target population, navigation and resource connections, the creation of a social needs team and workflow, data collection and evaluation, and community partnerships.

In the case study, researchers analyzed Health Leads over a 20-year period and its effect on a community through the 5 stages of diffusion: testing and learning, model standardization, model replication, a shift from doing to enabling, and catalyzing broad adoption.

The Health Leads case study highlights three lessons regarding the diffusion of an innovation in healthcare. The first lesson is to focus on a clear aim, which compels innovators and investors to believe in the model approach and support diffusion.

The second is the need to invest in model testing. The diffusion of Health Leads did not follow a linear pathway due to its exposure to multiple market shifts, creating a sustainable adoption by institutions.

The final lesson from the case study was to cede control of the model. A high-quality social needs intervention program must evolve to fit the needs of the local community. Likewise, if investors have too much control over the program, then the investors’ desires will be met rather than the patients’.

“This 20-year case study reinforces the importance of a relentless, collective focus on a clear aim to enable the diffusion pathway,” the authors concluded. “The healthcare sector has now recognized that population health, patient- and community-centered care, health equity, and utilization and cost reduction are unachievable absent addressing patients’ social needs and the well-being of communities.”


Onie RD, Lavizzo-Mourey R, Lee TH, Marks JS, Perla RJ. Integrating social needs into health care: a twenty-year case study of adaptation and diffusion. Health Aff. 2018;37(2). https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2017.1113. Published online February 5, 2018. Accessed February 20, 2018.

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