Three Questions with Dahei Yue on Health Care

Dahai Yue is a graduate student researcher at the UCLA Center for Health Policy Research. He is the lead author of a new Health Affairs article about how nonclinical services can improve access to health care. 

Q: What are enabling services and why are they important for patients? 

Enabling services are non-clinical services that aim to increase access to healthcare and improve health outcomes. They include care coordination; health education; transportation; and assistance with obtaining food, shelter, and benefits. These services address patients' challenging and complex situations in which health care is delivered and are particularly crucial for vulnerable populations. 

For instance, for patients with diabetes, an appropriate diet is as important as medications to keep their blood sugar levels under control. For patients with disabilities, help with transportation would be needed for them to visit doctors for their needed care. Health Resources and Services Administration (HRSA)-funded health centers’ provision of enabling services expands their reach beyond the walls of the clinical setting and is a pillar of their comprehensive care delivery model. 
 

Q: What does this research mean in terms of health care costs and looking at social determinants of health? 

This research has broad implications on reducing health care costs by improving social determinants of health (factors such as education, physical environment, and social networks). Our results show that the systematic delivery of enabling services improves patients’ use of primary and preventive care, as well as their satisfaction of care received. 

As primary care promotes the receipt of appropriate care and contributes to better health outcomes, enabling services have implications for optimizing health and cost savings in the long-term. The use of preventive services could prevent disease development and premature death, and forgoing preventive services could come at both a personal and a societal cost. However, enabling services are not directly reimbursable by most payers (in other words, insurance companies do not pay providers directly for these types of services), especially those with fee-for-service payment model. Health centers rely on a combination of Medicaid reimbursements and grants from HRSA (or money from the federal government) to deliver enabling services. The lack of a standard methodology for payment for enabling services imposes significant challenges for adequate reimbursement. 
 

Q: How can the data be used to inform policy? 

Enabling services play a crucial role in increasing access to high-quality health care and improving the use of preventive services among HRSA-funded health center patients. As the US health care system increasingly focuses on a value-based care delivery model (or rewarding doctors and other service providers for providing quality care), enabling services could be explicitly included to improve care for those high-cost, high-need patients. Moreover, examining reliable funding streams and US financing policies, and designing a sustainable model for delivering enabling services, especially in low-income populations, would ensure the delivery of these services. Continuous support for enabling services could improve the health of these populations, reduce costs, and reduce health disparities in the long run.