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Social Workers Play New Strategic Role in Accountable Care Organizations

BY PATTI OLIVER – As Blue Shield of California works toward delivering healthcare worthy of our family and friends that is sustainably affordable, we’ve expanded our focus. We continue to ensure members with complex needs are receiving the right care at the right time in the right place. However, we’ve also learned that in order to meet patient needs more effectively and efficiently, we need to address social, economic and lifestyle barriers that could impact patient quality and outcomes.

 

To accomplish this, Blue Shield of California’s Accountable Care Organization (ACO) program has enlisted social work program managers to be an integral part of the clinical team. The program managers provide social work perspective and add valuable input related to behavioral health, substance abuse, and psychosocial needs to all of our clinical initiatives.

Rachel Velasco-Acosta, a licensed clinical social worker (LCSW), kicked off Blue Shield’s ACO social work program in 2016. She has 20 years’ experience in various areas of clinical social work including dialysis, emergency departments, rehabilitation, and leadership. She is currently completing her doctoral program in behavioral health with a focus on population health management. Over the past year, she has been working to integrate behavioral health into clinical initiatives to address Blue Shield members’ needs. Mary Nickel-Nguy, also an LCSW, joined the ACO team last year. Mary’s background includes extensive work in acute settings, heart failure, criminal justice, and higher education. She is completing a doctorate program in clinical social work.

Together, Rachel and Mary support ACO work across the state by meeting with physician groups and hospitals, observing best practices in both inpatient and outpatient setting. They identify gaps in care delivery and connect ACO groups with Blue Shield behavioral health resources. They explore creative solutions to provide early interventions for patients who have chronic health conditions, such as diabetes, asthma, and coronary artery disease, with related behavioral health issues, such as depression and anxiety. The goal is to improve patients’ health through a holistic approach to treatment.

In hospital emergency departments, the ACO social work program management team is having a positive impact on patients and their families by addressing their psychosocial needs in addition to their medical issues. For example, our program managers have been working with hospitals to encourage them to add a dedicated emergency room social worker. In doing so, hospitals can improve the emergency department’s experience for everyone involved – through identification of community programs, education to providers on screening of co-occurring behavioral health conditions and chronic medical conditions, and education to patients and families.

These social workers can assist patients and families with resources such as access to reliable transportation. This is an important area of need because when patients leave the hospital, but can’t get to medical appointments or procedures because they lack transportation, their health can suffer, impacting their overall quality of life. Social workers alleviate these types of problems by connecting patients with critical community resources.

Blue Shield’s ACO social work team’s recommendations are designed to improve overall health outcomes for patients, reduce hospital readmissions and inappropriate use of the emergency department, and create a unified approach to wellness for patients. Our ACO collaborations with physicians and hospitals foster environments to develop strategies for comprehensive patient care, both behavioral health and medical care. Our clinical ACO team – now featuring this social work component – is determined to help address both using a creative approach to promote optimal health outcomes for our members.

Patti Oliver, R.N., is senior director of clinical programs at Blue Shield of California


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