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Health Aff (Millwood). 2016 Nov 1;35(11):2109-2115.

Housing, Transportation, And Food: How ACOs Seek To Improve Population Health By Addressing Nonmedical Needs Of Patients.

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Taressa Fraze ( is a research scientist at the Dartmouth Institute for Health Policy and Clinical Practice, in Lebanon, New Hampshire.
Valerie A. Lewis is an assistant professor at the Dartmouth Institute for Health Policy and Clinical Practice.
Hector P. Rodriguez is a professor of health policy and management and codirector of the Center for Healthcare Organizational and Innovation Research, both at the School of Public Health, University of California, Berkeley.
Elliott S. Fisher is director of the Dartmouth Institute for Health Policy and Clinical Practice.


Addressing nonmedical needs-such as the need for housing-is critical to advancing population health, improving the quality of care, and lowering the costs of care. Accountable care organizations (ACOs) are well positioned to address these needs. We used qualitative interviews with ACO leaders and site visits to examine how these organizations addressed the nonmedical needs of their patients, and the extent to which they did so. We developed a typology of medical and social services integration among ACOs that disentangles service and organizational integration. We found that the nonmedical needs most commonly addressed by ACOs were the need for transportation and housing and food insecurity. ACOs identified nonmedical needs through processes that were part of the primary care visit or care transformation programs. Approaches to meeting patients' nonmedical needs were either individualized solutions (developed patient by patient) or targeted approaches (programs developed to address specific needs). As policy makers continue to provide incentives for health care organizations to meet a broader spectrum of patients' needs, these findings offer insights into how health care organizations such as ACOs integrate themselves with nonmedical organizations.


Determinants Of Health; Health Reform; Organization and Delivery of Care; Primary Care; Public Health

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