Tech for Social Prescribing in the US

An overview of American technologies to address Social Determinants of Health

Photo by Corinne Kutz on Unsplash

Ugh, not again. Another breakup. Your chest has been hurting since things ended with Suzy (she was such a catch! I let another goodie get away!). You go to the doctor. You get a otoscope down your ear canal, stethoscope across your back. Both you and the doctor kindly nod to your diagnosis: loneliness.

What should the doctor do? Call Suzy and convince her of your merits?

No.

Unfortunately, in the American health system the most physicians can do is dejectedly suggest a support group with a pat on the back.

But not in the UK! Britain’s National Health Service (NHS) is pioneering a new medical innovation taking the world by storm. It’s called Social Prescribing. Doctors prescribe patients to take part in local volunteer and social activities. Social Prescribing might engage you with community gardeners in London, invite you to join a group of old ladies playing Bridge in Rotterdam, or help you find purpose mentoring toddlers along Brighton Beach. The UK is investing millions to enable social prescribing in EVERY general practice in the UK. Canada, Australia, and Japan are also expanding their efforts nationally.

What about the US?

The language of providers in the US is not focused on “Social Prescribing.”

Social Prescribing in the US, instead, falls under the broad umbrella of addressing Social Determinants of Health (SDoH), and more narrowly to connecting patients to local “Social Services.” Most solutions for providers are primarily focused on addressing the bottom of Maslow’s Hierarchy of Needs (housing, food, legal help), rather than the top (social connection and belonging).

SDoH Tech

Some major tech platforms have sprouted up. Most include searching for and making referrals to social service prescriptions, tracking of completion, etc:

• Unite Us — is a social service referral platform. They partnered with Kaiser Permanente and plan to eventually reach all of Kaiser’s 12 million members. They integrate with current healthcare technologies, tracking of referral completion, analytics, and decision support for clinicians. Unite Us also helps the medical systems develop their local referral network and onboard partners.
• Healthify — Originating from Baltimore health clinics, Healthify has similar features to Unite Us; they emphasize collecting data needed for Accountable Care Organizations and Medicaid reimbursements. An early case study at Reading Hospital showed success: $1M savings in emergency medical care costs, 15% reduction in Medicare and Medicaid emergency visits, 15% reduction in emergency department costs. As for scale, Healthify 53 employs (listed on Linkedin) while Unite Us claims 225.
• NowPow — Dr. Stacy Lindau out of University of Chicago made “e-prescribing” community resources “as easy as medication”. The tool auto-refers patients to community resources based on needs in their medical record. The tool has been studied in an RTC (2018, AJPH). NowPow frames the service as “self-care” and allows app referral partners to get a shared view of the patient.

These products may sound perfect. But they have flaws. (1) Referral-tracking data is likely poor quality. Tracking requires compliance from many different stakeholders who don’t always follow through. This reality has been confirmed by my contacts researching Social Prescribing in the UK (2) The social sector may not have bandwidth to handle the influx of new referrals. This is why some pilots in England involve commensurate funding for social sector. (3) Lonely, depressed patients often need coaching to successfully make use of services/social opportunities. This is backed by findings in the UK (4) Despite these expensive solutions, free sites exist to find social services:

• Aunt Bertha — allows you to find social services for free by zip code and is integrated into EMR software at the healthcare behemoth Epic.
• MAPSCorps — trains youth to produce high quality data on community assets. This is an initiative also led by Dr. Lindau of NowPow.
• UnitedWay 211 — toll free call service that helps connect people to the essential health and human services they need, 24 hours a day, seven days a week.
• FoodFinder — helps you find food pantries in your zip code.

Still, these platforms are an important step to SP adoption. Providers can partner with scaled social sector organization, like Park Run and Revel, or IoT apps, to better ensure data tracking. Reliable data can drive more funding for the social sector. A robust referral network can drive adoption of physician training and “community link” positions.

Medicare & Medicaid

Some organizations are more focused on Medicare and Medicaid patients:

• Uno health — specializes in enrolling Medicare members in state and federal cash assistance they are eligible for. Insurers can capture the $8 billion a year risk adjustment revenue not being captured by the 30% of medicare patients who go unenrolled.

We will likely see more Medicaid solutions sprout up as states can now fund experimental SDoH initiatives through Medicaid 1115 waivers.

Social Connection Tech

Some organizations do focus strictly on building social connections:

• Wider Circle — brings “neighborhood health” to 135 communities. Through escalating involvement, facilitators organize in-person neighbor groups. The neighbors help each other navigate care and support each other.
• Revel — a new startup building relationships and community for women over 50. I spoke to the founder and they are working on getting user reimbursement from health plans.
• Papa, Inc — partnered with Humana to provide “family on demand.” They pair college students with older adults to assist with everyday tasks
• Marigold Health — combines relatability of peer support groups with clinical mental health and substance use care.
• ClubHouse– an app for drop-in audio conversations. Join a conversation or start your own
• Group Therapy — looking for platforms and providers
• Peer Support Groups — looking for platforms and providers

Each of these has a different connection-organizing method and business model. Hopefully a few methods will surface as most effective.

Research Platforms

Those looking to research SDoH can use the CDC data resources on Social Determinants of Health. The site contains:

1. Geographic data on SDoH: economic status, environmental influence, social and economic vulnerabilities
2. Geographic data on illness: heart/kidney/chronic disease, disabilities, HIV

Additional:

• Healthify Blog; their founders post on how to systematically address SDoH
• Unite Us Blog