The National Academies of Sciences, Engineering, and Medicine’s Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health report details how hospitals and health systems can use processes, infrastructure, and education to improve the integration of services that address health-related social needs.

The report includes recommendations for identifying patients’ social needs and addressing them through partnerships with and referrals to community-based organizations (CBOs).

The report also recommends that health systems alter clinical care to accommodate social barriers, connect patients with social care resources, identify community services or assets to partner with or invest in, and promote policies for resources that address health and social needs. In addition, the report includes recommendations for training the health care workforce around social determinants of health; developing interoperability infrastructure and data-sharing capabilities, particularly with CBOs; and continuing to build the evidence base and related measures to address social needs around health care.

The report’s recommendations are consistent with efforts of the hospitals and performing provider systems implementing New York’s Delivery System Reform Incentive Payment (DSRIP) program to address social needs as part of broader population health improvement efforts.

GNYHA continues to support hospitals implementing social determinants of health assessments, referrals, and CBO partnerships. Tools, resources, and additional information are available here. Hospital staff responsible for social determinants of health strategy can also join GNYHA’s Social Determinants of Health Workgroup.