Community Supports: Addressing Social Determinants of Health
California's innovative CalAIM initiative is taking a bold step in recognizing that health is about more than just medical care. Through its Community Supports program, CalAIM is directly addressing social determinants of health (SDOH) - the conditions in which people are born, grow, live, work, and age that significantly impact their health outcomes.
Social determinants of health encompass a wide range of factors that significantly influence an individual's health outcomes, often more so than medical care alone. These determinants include economic stability, which involves aspects like employment, income, expenses, debt, and medical bills. The neighborhood and physical environment also play a crucial role, encompassing housing conditions, transportation access, community safety, and the availability of parks and playgrounds. Education is another key determinant, covering literacy, language skills, vocational training, and access to higher education. Food security and nutrition are vital, addressing issues of hunger and access to healthy food options. The community and social context in which a person lives is equally important, including social integration, support systems, and community engagement. Lastly, the healthcare system itself is a determinant, involving factors such as health coverage, provider availability, and quality of care. By addressing these social needs through CalAIM's Community Supports, the initiative aims to improve health outcomes, reduce healthcare costs, and enhance the quality of life for Medi-Cal members. This comprehensive approach recognizes that true health and wellbeing extend far beyond the doctor's office or hospital, encompassing all aspects of an individual's life and environment.
CalAIM offers 14 pre-approved Community Supports that Medi-Cal managed care plans can provide to eligible members. These services are designed to be medically appropriate and cost-effective alternatives to traditional medical services. Let's briefly overview each of these supports:
Housing Transition Navigation Services: Assists homeless individuals or those at risk of homelessness in finding, applying for, and securing housing.
Housing Deposits: Provides financial assistance for security deposits, utilities set-up fees, and initial rent payments to help members secure housing.
Housing Tenancy and Sustaining Services: Supports members in maintaining stable housing through coordination with landlords, assistance with recertification, and linkage to community resources.
Short-Term Post-Hospitalization Housing: Offers temporary housing for up to six months for members with high medical or behavioral health needs who lack a residence after hospital discharge.
Recuperative Care (Medical Respite): Provides short-term residential care for individuals who no longer require hospitalization but still need to recover from an injury or illness.
Respite Services: Offers short-term relief for caregivers of Medi-Cal members.
Day Habilitation Programs: Provides mentoring and skill-building for individuals experiencing or at risk of homelessness to help them live independently in the community.
Nursing Facility Transition/Diversion to Assisted Living Facilities: Supports members in transitioning from nursing facilities to assisted living facilities when appropriate.
Community Transition Services/Nursing Facility Transition to a Home: Assists members in transitioning from nursing facilities to private residences by funding set-up services.
Personal Care and Homemaker Services: Provides in-home support for activities of daily living and instrumental activities of daily living.
Environmental Accessibility Adaptations (Home Modifications): Offers physical modifications to a member's home to ensure health, safety, and greater independence.
Medically-Supportive Food/Medically Tailored Meals: Delivers nutritious meals, healthy groceries, and nutrition education to support members' health needs.
Sobering Centers: Provides a safe, supportive environment for publicly intoxicated individuals to become sober, along with substance use education and counseling.
Asthma Remediation: Offers home modifications to reduce environmental triggers for asthma.
By offering these Community Supports, CalAIM aims to address the root causes of many health issues. For instance, providing housing support can lead to better health outcomes by offering stability and reducing stress. Medically tailored meals can help manage chronic conditions like diabetes or heart disease. Asthma remediation can significantly reduce asthma attacks and related hospitalizations.
These services not only improve individual health but can also lead to significant cost savings for the healthcare system by reducing emergency room visits, hospitalizations, and the need for more intensive medical interventions.
CalAIM's Community Supports represent a groundbreaking approach to healthcare that recognizes the profound impact of social factors on health. By addressing social determinants of health, these services have the potential to dramatically improve health outcomes, reduce health disparities, and create a more equitable healthcare system in California.
As this program continues to roll out across the state, it will be crucial to monitor its impact and learn from its implementation. The lessons learned from CalAIM's Community Supports could pave the way for similar initiatives across the country, potentially transforming how we approach healthcare and social services nationwide.