8
Reflections on the Day
To conclude the workshop, Daniel Polsky provided a short summary of the two key messages he heard throughout the day. The first was there is underinvestment in social needs. Speaking from the perspective of an economist, he said it is clear there are many places where the market does not function properly, such as in the case of the “wrong pockets” problem that several panelists mentioned and the long time frame over which returns for many interventions are realized. Value-based payment, he said, can be a wonderful approach for addressing this underinvestment because economic incentives do work.
The second key message was that more research is needed, and there is an opportunity to think about infrastructure that could lead to more rigorous, evidence-generating research. He noted the panelists had many great ideas around evidence standards, using more administrative data, addressing privacy issues, and making linkages across disciplines and organizations.
Polsky then opened the floor to comments from the workshop participants. One unidentified participant from the American College of Preventive Medicine suggested there are many places where preventive medicine specialists could serve as the bridge between clinical care and community needs. This participant also proposed that one infrastructure investment would be to offer cross-training during residencies for new physicians who want to work at the intersection of prevention and population health.
Another participant suggested there are other approaches to proving an intervention is effective, such as realist evaluation and Shewhart
statistics, that are not time-consuming, randomized controlled trials. A third participant suggested looking at systems-based interventions that are not traditionally thought of as addressing social determinants of health. As a final comment, Uche Uchendu said she would like to see more overt emphasis on health equity and health disparities in this work because the assumption that addressing social need and social issues will take care of health equity issues is usually incorrect.
