This paper looks how health systems can go beyond clinical care to address the social determinants of health and considers why this approach might be particularly relevant for Accountable Care Organizations touted by the Affordable Care Act. ACOs make profits by reducing the medical expenses of patient populations. The leading causes of death in the United States are tobacco use, insufficient physical activity, and an unhealthy diet. These risk factors are linked to increased incidence of a wide range of chronic (...) diseases, the treatment of which places a tremendous financial burden on our health care system. Health care delivery and access are just a small part of the solution to our chronic disease crisis. Increasingly, strategies that address the social determinants of health —“the conditions into which people are born, grow, live, work, and age”— are the ones that hold the most promise. In Massachusetts, Steward Health Care System supports a number of initiatives to address the social determinants of health in its patient population. Steward provides an example of how a hospital system can address the health of its patient population by moving beyond clinical care. The varied initiatives have also resulted in cost savings for the system. (shrink)

The Affordable Care Act and other federal initiatives are fostering the emergence of a coherent vision for chronic disease prevention that has never before existed in the United States. This investment in population health and prevention comes not a moment too soon. Health care costs are proving very difficult to control and are rising at an unsustainable rate, driven in part by sky-rocketing chronic disease rates.This article looks at how a health system can engage in prevention activities beyond the clinical (...) setting and makes a strong case that these interventions will result in documented cost savings. We first examine an individually targeted strategy that helps patients obtain health insurance coverage. This strategy furthers a hospital's goal of receiving reimbursement for care while also having the social benefit of increasing patients’ economic stability. (shrink)