Why Social Work? Providing a Research-Based Rationale for Social Work Services in the Era of the Affordable Care Act

Decades of empirical and theoretical work have contributed to our modern understanding of health as multifaceted and determined by social, environmental, economic, and psychological factors, in addition to biological and medical factors. Patients with chronic health problems and multiple non-medical barriers to managing health conditions are at greatest risk for poor outcomes, emergency department visits and long, frequent inpatient hospital stays. In healthcare settings, social workers provide psychosocial counseling and case management aimed at addressing non-medical barriers to health. Social workers connect patients to appropriate outpatient care and provide concrete resources that enable patients to access community care, which is important in order to avoid unnecessary emergency and inpatient visits. 

This role is becoming increasingly important as the Affordable Care Act (ACA) attempts to address inequalities in healthcare access and delivery of quality care through two major provisions. First, the ACA will expand the insurance market to historically uninsured, low-income patients who often face a combination of medical, social and economic hardship that place them at risk for chronic and difficult to manage health conditions. This will mean an increase in insured patients who need psychosocial and care coordination services to address non-medical barriers to health. Second, the ACA’s Hospital Readmission Reduction Program reduces Medicare payments if hospitals report “excess readmissions” or readmission to a hospital within 30 days of a previous discharge. This provision highlights the importance of quality care and the fiscal implications that could result if healthcare systems fail to attend to all of the factors, medical and non-medical, that impact patients’ health and risk for readmission. Social work’s service models, mission and experience attending to non-medical health barriers make it a well-positioned profession to appropriately address these ACA provisions, but empirical evidence of social work service outcomes and a research-based rationale is needed to reinforce social work’s ongoing role in improving access and quality care.

This roundtable will present research on ways in which unmet psychosocial needs affect healthcare use and emerging models of care aimed at addressing the needs of high-risk patients. We will focus on models of psychosocial care within the primary care setting including the patient-centered medical home and programs targeting the needs of patients who are high utilizers of the emergency department and inpatient medical services. We will suggest how social work can address these changes in care priorities and contribute to improving healthcare for some of the nation’s most underserved and vulnerable populations. This information will be used to highlight gaps in knowledge and directions for social work research that are needed to sustain medical social work in the era of the ACA.