The National Academy of Medicine Social Care Framework and COVID-19 Care Innovations

Despite social care interventions gaining traction in the US healthcare sector in recent years, the scaling of healthcare practices to address social adversity and coordinate care across sectors has been modest. Against this backdrop, the coronavirus pandemic arrived, which re-emphasized the interdependence of the health and social care sectors and motivated health systems to scale tools for identifying and addressing social needs. A framework on integrating social care into health care delivery developed by the National Academies of Science, Engineering, and Medicine provides a useful organizing tool to understand the social care integration innovations spurred by COVID-19, including novel approaches to social risk screening and social care interventions. As the effects of the pandemic are likely to exacerbate socioeconomic barriers to health, it is an appropriate time to apply lessons learned during the recent months to re-evaluate efforts to strengthen, scale, and sustain the health care sector’s social care activities.

In recent years, social care interventions in the US health care sector have gained traction, driven by compelling research, payment reforms, and new technology.¹ Despite this momentum, the scaling of new health care practices to address social adversity has been modest, and examples of sustainable alignment or coordination of care across sectors are scarce.² Against that backdrop, the new coronavirus arrived in the USA. In response, numerous academic, trade, and lay press publications highlighted how vulnerable populations disproportionately shoulder the growing pandemic’s burdens.^3–9 By re-emphasizing the interdependence of the health and social care sectors, the COVID-19 experience also has led health systems to develop, deploy, and scale tools for identifying and addressing patients’ social needs with new urgency.¹⁰Yet feasible and effective roles for health care systems in attending to patients’ social and economic needs remain elusive. A 2019 framework from the National Academies of Sciences, Engineering, and Medicine (NAM) described five strategies health care organizations can leverage to strengthen social care: awareness, assistance, adjustment, alignment, and advocacy.¹¹ (See Table ​Table1.)1.) We use the NAM framework to highlight promising social care integration innovations spurred by the COVID-19 pandemic and to recommend opportunities for strengthening and sustaining those efforts in the context of the virus’ long-term economic sequelae.Table 1Social Care Categories, Practice Examples from COVID-19 Pandemic, and Opportunities for Scaling

NASEM category*	Definition	COVID-19 pandemic examples	Opportunities for health care sector to strengthen and scale social care
Awareness	Activities related to identifying the social risks and assets of defined patients and populations	Near-universal screening for homelessness at clinical entry points	Establish consensus on standards for documenting both social adversity and related interventions
Adjustment	Activities related to altering clinical care to accommodate identified social barriers	Waived fees for viral testing and home medication delivery	Strengthen evidence on benefits and harms of adjusting care for different at-risk populations
Assistance	Activities related to reducing social risk by connecting patients with social care resources	Expansion of home-delivered meals and provision of temporary housing	Improve EHR integration of community resource referral technology; reimburse community agencies for providing effective assistance programs; increase the scale and training of the workforce providing assistance
Alignment	Activities undertaken by health care systems to understand existing social care assets in the community, organize them to facilitate synergies, and invest in and deploy them to positively affect health outcomes	Data sharing across sectors to mobilize housing for homeless patients	Invest in shared data standards and digital infrastructure across sectors to increase seamless data sharing
Advocacy	Activities in which health care organizations work with partner social care organizations to promote policies that facilitate the creation and redeployment of assets or resources to address health and social needs	Health care advocacy for paid sick leave	Advocate for policies that facilitate and augment social care resources, such as recovery legislation

Open in a separate window*National Academies of Sciences, Engineering, and Medicine report on Integrating Social Care into the Delivery of Health Care, 2019¹¹