Americans are suffering from an unequal health care system in which some people have resources and receive excellent care while others lack access to basic and essential services. Despite the entrenched and systemic nature of some of these barriers, there are vehicles for change on the horizon.
Nearly 80 percent of health outcomes are directly impacted by social determinants of health (SDoH) which is a term that encompasses social factors such as nutrition, economic stability, and housing that directly impact both an individual’s health and ability to access and adhere to treatment. Health equity cannot be achieved without addressing SDoH. While no single profession is capable of eradicating deficits and barriers in SDoH, social workers play a critical role in the delivery of comprehensive health care because they are uniquely trained to reduce the risks and barriers that derail even the best treatment plans.
Social workers serve as case managers who plan and coordinate resources with patients and families both in and out of the hospital. They can connect patients with community support, arrange transportation, provide financial planning, and ensure a safe discharge, including setting up long-term services. When social workers are on health care teams, everyone benefits. For example, among Veterans Health Administration (VHA) patients, integrating social workers into primary care teams decreased the risk of acute hospital readmission and specifically reduced the risk of urgent care visits. Recognizing the role of social workers in tackling complex needs begins with understanding the value these health professionals bring to the lives of patients and seeing the reverberating impacts across the escalating costs of health care.
Despite the positive impact of social workers in delivering comprehensive health care, including addressing SDoH, the financing and support of social work in certain care settings providing case management remains limited. Social work faces a lack of payment structure and reimbursement to provide case management services independently. Without the ability to bill independently for case management services – and to do so for services beyond psychotherapy services – there are systemic limitations for patients and health systems in receiving the full expertise of social workers. Embedding the social work labor force into ambulatory care to address health-related social needs would ensure greater patient access to comprehensive patient-centered treatment plans.
With legislative and administrative pathways to correcting these payment and access issues, we are at a critical juncture.
Last month, the Integrating Social Workers Across Health Care Settings Act, H.R. 4638, was introduced by Representatives Danny Davis (D-IL-07) and Jen Kiggans (R-VA-02). This legislation would authorize clinical social workers to bill Medicare when providing services within their state scope of practice, which will increase workforce capacity and thereby remove barriers for access to mental and behavioral health services among our nation’s elderly and disabled populations.
The Centers for Medicare and Medicaid Services released the calendar year (CY) 2024 Physician Fee Schedule (PFS) proposed rule in August and made the same call to invest in the clinical social work workforce. This annual regulatory rule updates reimbursement rates and policies on health care, and the CY 2024 proposal would allow social workers to bill for certain services relating to health interventions and care management.
With expertise in navigating communities and health care systems, social workers build connections for better health outcomes and address SDoH barriers. Payment structure limitations are depriving some of our nation’s most vulnerable patients of care because of the disparity and recognition of social workers as capable and essential health professionals. As the primary health labor force trained on social care, social workers are the answer to addressing SDoH and achieving health equity.
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.
LaCinda Jones, Robyn Golden, and Laura Taylor are social workers.