Advancing health equity is a top priority for nearly all health systems, but making progress can be complicated. Becker's Hospital Review recently spoke with Melissa Sherry, Vice President of Social Care Integration at Unite Us, about challenges and opportunities related to adopting health equity services at scale.
Note: Responses have been edited for length and clarity.
Question: Tell us about the mission of Unite Us and your role as vice president of social care integration
Melissa Sherry: As a company, Unite Us aligns stakeholders across sectors with the shared goal of improving health. What that really means is we build networks of community-based organizations. We are boots on the ground, bringing together nonprofits and community-based organizations that serve different types of social needs. We connect with technology, in pursuit of better health outcomes. All community-based organizations can use Unite Us's technology for free.
In my role as Vice President of Social Care Integration, I lead our payments work. Unite Us Payments is about bringing more funding into community-based organizations to pay for social services and increase their capacity to serve communities. I also lead research and evaluation, as we are looking at how to tell the story and prove the value of investment in social care.
Q: What are examples of the impacts you see in communities where Unite Us operates?
MS: I'm passionate about research, evaluation, and proving the value of social care. When I started at Unite Us, one thing we did was think about different value drivers we see when community-based organizations use our technology to refer people out to get their social needs met.
We like to look at community-based organizations in our network and identify ways to increase their capacity. We give them their own data so they can quantify gaps between how many referrals they are getting and how many people they are able to serve due to capacity constraints.
Through Unite Us' payments technology, we're starting to drive more funding into communities. We recently coinvested $1 million with our partners at Metro United Way in Louisville to fund a program aimed at helping single mothers, especially mothers of color, who are struggling. The program helped them stay housed, become more financially independent and meet their social needs so they could have a chance at a better life. We deployed our technology and worked with different community-based organizations who received funding and helped them track those funds.
When we looked at the impact these community-based organizations had on women's lives, the stories we heard were amazing. One person just needed a bike lock so they could bike to pick up documents necessary for starting work and not worry about their bike getting stolen. We also looked at the healthy days measure, which evaluates a person's perception of their health and mental well-being. We did a pre/post study and saw incredible results from programs geared at meeting people's basic needs so they can get back on their feet.
Q: With heightened emphasis on social determinants of health and health equity, what major challenges do healthcare providers face when trying to adopt health equity services at scale?
MS: Providers face a range of challenges related to health equity and social needs. The first is finding people whose social needs may prevent them from seeking services. If individuals are homeless or don't have transportation, they may be unable to see a primary care provider or take medications appropriately. As a result, those people often present in the ER.
Another challenge for providers is screening for social needs. Who should do that screening? Where does it fit in the workflow? What questions should providers be asking? The answers to screening questions often have interesting implications for how providers practice medicine. For example, if a patient doesn't have electricity at home or is homeless, it's not practical to prescribe a medication that needs refrigeration. Doctors need to make workflow changes and different decisions based on people's social needs.
A third challenge is having the ability to link individuals who screen positive for a social need to services that can help address those needs, and knowing whether or not the person got their need met. Companies like Unite Us provide tools to screen patients, refer them out, connect them to the social services they need, and provide information back on whether or not the need was met, so they can get back on track with their healthcare.
Q: Unite Us has been involved with multiple state-sponsored programs for improving access to social care services. While public sector funding is important, are private sector care delivery organizations or payers interested in funding social care services?
MS: Absolutely. What's exciting about the current moment is that we're seeing both the public and private sectors invest in social care to improve equity outcomes. For instance, North Carolina's Medicaid 1115 waiver is providing $550 million in funding for community-based organizations. Many players from the public and private sector are coming together to make that happen. North Carolina is using the Unite Us infrastructure to send and receive secure referrals, coordinate social care across the state, and pay community-based organizations for services as part of the Healthy Opportunities Pilots.
Significant opportunities also exist for private and nonprofit hospitals and health systems to use community benefit dollars a bit differently. One solution we offer at Unite Us is detailed tracking of how community benefit dollars are spent in the community, so hospitals can better understand where dollars were spent, which community services increased with these investments, and the types of patients served.
Q: Advancing health equity can be challenging. What's your advice for health systems who want to get started, but don't know where to begin?
MS: Health equity can definitely seem complicated and overwhelming, but it's pretty simple to get started. My best advice is to look at what other states, payers, and health systems are doing. You can start with something as simple as screening for social needs, so you better understand the challenges facing your populations and then implement tools and programs to address those needs. Unite Us can walk you through the process step-by-step. Don't be intimidated. It's the right thing to do and can make such a positive impact.