Researchers at the Yale School of Public Health have discovered that increased collaboration between health care providers and other social service organizations might lower readmission rates to hospitals.

Fostering these collaborations would also lower health care costs, according to the Yale paper, which was published in the journal Health Services Research on Sept. 19.

Elderly Americans, a small subset of the overall U.S. population, account for over a third of the nation’s health care spending. Additionally, the elderly make disproportionate use of a variety of social services, ranging from Meals on Wheels to affordable housing agencies to elderly assistance providers.

In communities across America, hospitals and social service providers have begun joining forces to address the unique needs of the elderly. Since these providers aid similar populations and share many of the same goals, these collaborations have been beneficial to the overall communities, said Amanda Brewster, first author of the paper. In order to form a more comprehensive picture of how these interactions have affected communities and their elderly residents, the research team interviewed 245 representatives of local governments, health care organizations and other social services groups in communities across the nation.

“There’s increasing interest across the health care sector regarding the impact of getting involved in organizing social services across the community, but right now, there’s really limited information on what configurations work at the local level,” Brewster said.

Overall, she added, the researchers found that communities in which health care services are integrated with other social programs tend to have lower health care costs and fewer unnecessary readmissions. While there is no nationwide framework to coordinate health care and other social services, hospitals have begun taking the initiative in working with organizations that aim to address the needs of the elderly. The collaboration benefits both parties and cuts down on unnecessary health care expenditures, Brewster said.

Brewster became interested in studying the connections between health care providers and other social services organizations while studying how hospitals minimize readmission rates. After speaking with hospital employees and administrators, Brewster learned that elderly patients often return to the hospital because of non-medical challenges, such as food insecurity or housing instability — especially if they lack a strong support system at home. It was this revelation that inspired her to turn the attention of her research to studying the nonmedical methods being used to lower health care costs and readmissions in communities as a whole.

Unlike many other solutions proposed to cut health care costs, the collaborations between hospitals and social service providers grow organically out of the communities in which they exist. Individuals and groups have taken the initiative at a local level to solve a problem, and as a result of that on-the-ground focus, their solutions are more likely to succeed, said Leslie Curry, professor at the School of Public Health and a co-author of the paper. This approach is known as positive deviance, she added.

“This method assumes that communities themselves possess the wisdom to solve their most pressing challenges, rather than well-meaning outsiders,” Curry said.

To carry out the study, the researchers first had to build rapport by reaching out over the phone to people working in social services and health care on the ground, said Annabel Tan, a co-author of the paper. Having built trust, they were then able to fly out to those communities and formulate an understanding of the unique ways hospitals were working with social service organizations. The researchers then compiled results in the paper, which describes the qualitative impact of the collaborations on communities.

“A qualitative study is really meant to dive in and understand the phenomenon that you’re interested in in a really nuanced way,” Brewster said. “The trade-off is that you can’t generalize that much.”

In order to generalize their findings, the researchers are gathering data to create a model that quantifies the results of the study. For example, they plan to examine how the collaborations investigated in the study affect health care spending.

According to the Centers for Medicaid and Medicare Services, U.S. health care spending reached $3.2 trillion in 2015.

Maya Chandra | maya.chandra@yale.edu