The Future of Social Services: Building a Resilient Social Care Network in New York

As health and social needs become more complex, our delivery system must evolve, making a strong and integrated Social Care Network (SCN) more urgent than ever. The SCN, a potential $3.7 billion investment in New York's health, will provide health and social needs screening services, navigation services, and direct social services in thirteen funded regions across the state. An SCN facilitates comprehensive and efficient care by addressing social determinants of health and tracking their impact on health outcomes for vulnerable populations.

The Vision and Value of SCN

The SCN is designed to bring social services directly to those who need them the most, leading to better healthcare outcomes. New York’s social services and health providers should be eager to participate in this transformation of the health and social services landscape. We understand the need for community stakeholders to collaborate, share information, and create innovative solutions to address the diverse needs of the 7.3 million Medicaid population across New York State.

Our recent whitepaper, “Healthcare Service Delivery 3.0,” - https://anchorhealthexchange.com/white-paper/- noted that socioeconomic factors, often overlooked in traditional healthcare, significantly impact health outcomes. An SCN mitigates this by improving coordination, encouraging efficiency, and increasing service accessibility. Over the next three years, the SCN model will fast-track the interconnectedness of health and social services programs, unifying community-based organizations (CBOs), healthcare providers, and government agencies in a person-centered approach. This integration promises to foster holistic care addressing critical social determinants such as housing, food security, transportation, and social support.

Building the SCN

Current evidence shows that the value of an SCN lies in its ability to identify and bridge gaps in care. New York should be optimistic that state social service departments and CBOs can enhance their impact through a structured and adaptable SCN that seamlessly integrates health and social care services.

The Anchor Group is excited to support our clients in connection with this opportunity. One such client, CABS Health Network - https://cabshealthnetwork.org/social-care-network/ - aims to lead the SCN for Brooklyn under the theme “Community Helping Community,” leveraging its deep connections with CBOs, acute, post-acute, and ambulatory care facilities, elected officials, and advocacy and community members. The success of the SCN depends on collaboration, bringing together extensive knowledge in social services, healthcare, and technology integration, ensuring customized solutions that align with community needs.

Where to Start: Lead SCNs and Potential Partners

The Anchor Group believes that a comprehensive approach begins with community and CBO needs assessments, informing the leads of the strengths and gaps in the region they will serve. This promotes conversation and brings information to Medicaid members and potential implementation partners. A good lead SCN must be transparent, effective, and responsive, providing opportunities for a continuous feedback loop and promoting active partner, community, and member engagement.

Anchor Group’s Support for SCNs

The Anchor Group is uniquely positioned to support the implementation of an SCN. Our team of visionary leaders and network of strategic health and social services consultants, combined with access to the best technologies, will support the documentation, tracking, reporting, and recognition of quality services across the network. We are excited to help organizations build capacity to provide high-quality health-related social needs (HRSN) services in New York State. Four critical areas that lead SCN entities can leverage Anchor Group's support include:

1. CBO Assessment: Evaluating community-based organizations and their staff to strategically plan capacity-building, training, and funding initiatives.
2. Work Management Technology: Providing leads with the opportunity to define best practices utilized by all CBOs, with interventions tracked and scored, and continuous feedback from members and CBOs. Our Total Care Score software standardizes best practices, monitors interventions, and facilitates real-time feedback from members and CBOs. This technology will support seamless integration with existing health information systems like Healthix and SHIN-NY.
3. Building Networks: Leveraging our Stakeholder Engagement Model to build extensive networks among community-based organizations, healthcare providers, and government agencies for SCNs.
4. Human Capital Recruitment & Development: Utilizing our network to onboard health and social services professionals, strengthening ongoing professional development to maintain the standards of care and service provision.

The Road Ahead

New York State stands at an exciting and hopeful crossroads. Community-based organizations have an opportunity to retool their operations and access financial and training resources to provide more care to Medicaid members and sustain their businesses. The system built in New York over the next 36 months and the integration between community partners will position New York to better manage health and human services and strengthen the capacity of providers, insurance providers, and CBOs to respond to changing needs.

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