The following is an interview with Betsey Tilson, MD, MPH, Director and Chief Medical Officer for the North Carolina Department of Health and Human Services. She’ll be speaking as a panelist at our Cambridge meeting on December 2.

Austin Frakt: Among health care systems, plans, and programs, there has been increasing discussion of, if not investment in, approaches to addressing social needs. What is driving this phenomenon? Why is it happening now (as opposed to, say, 10 years ago)? 

Betsey Tilson: The consistent, growing, and compelling evidence of how social factors influence health, health care utilization, and health care costs have led to a growing recognition that improvement in health metrics will depend, at least in part, on addressing social risk. This momentum has been accelerated by the move towards value-based payments.

To what extent should the health system be involved in addressing social needs? After all, these are not traditionally in the purview of health care. Are the boundaries of health care shifting? Should they? 

Health systems should recognize social needs (e.g. through screening) but do not need to build or be the system addressing all those needs. Health care systems can connect, support, and resource the existing infrastructure to deliver social services.

Are we making progress in addressing social needs and/or social determinants of health? How would we know if we are? What would constitute “success”? How should we measure it?

One metric of success to follow would be health disparities which are often driven by underlying social circumstances. Success would look like improved health outcomes for everyone AND elimination of disparities between populations.

On the whole, are we seeing the kind of improvements we’d hope for from greater focus on social determinants and social needs? If so, can you highlight a success story? Or is this still a work in progress? 

There are a lot of examples showing how addressing social needs improves health and decreases costs and utilization in the context of a focused intervention and targeted population. For example, the evidence around medically tailored meals in the context of chronic disease, is compelling. What is lacking is evidence of how to scale multiple interventions across a heterogeneous population to improve overall population health – looking at both short-term and longer term outcomes. That is what we will be testing in our Healthy Opportunity Pilots as part of our Medicaid 1115 Demonstration Waiver.

For more on what the North Carolina DHHS is doing to address social determinants of health, see The Office of Healthy Opportunities and Healthy Opportunities Pilots, NCCARE360, and an Interactive GIS Map that allows for visualization of SDOH indicators.

Want to hear more from Dr. Tilson? Register for our event here!