Social workers' roles in patient care expand under affordable care act

Social workers will see their roles in patient care expand as hospitals and other providers draw on a range of professionals to meet the demands of the Affordable Care Act, experts told the Boston College Graduate School of Social Work Forum "Health Care Reform: From Policy to Practice."

Former Harvard Pilgrim Health Care CEO Charles D. Baker Jr., the keynote speaker, said social workers bring an expansive view of care options and can play crucial roles, particularly under a "team-based care" approach.

"When I think of social workers, I think of problem-solvers," said Baker, a gubernatorial candidate in Massachusetts. Speaking Monday to an audience of nearly 300 researchers, social workers and health care officials, Baker lauded social workers' abilities to "stitch clinical and social service issues together with real-life implications.

"They deal with the complexity of problems that don't fit neatly into categories."

Baker delivered the keynote speech at the graduate school forum, which examined the impact of the landmark health care legislation on the social work profession. National Association of Social Workers CEO Angelo McClain led a panel discussion on the topic with social work leaders.

"It is crucial for social workers to be engaged in ," said forum organizer and Graduate School of Social Work Associate Professor of Macro Practice Marylou Sudders. "One of the key aspects of the ACA is it promotes the integration of physical and behavioral health care – treating the whole person, not just managing symptoms. Social work, as a unique discipline that combines clinical and policy practice, stands to make a vital contribution to this new era of health care."

Instead of delivering "a political stump speech," Baker said he wanted to offer his views on the ACA's impact on and social workers, particularly in the areas of care management and therapy. A former Massachusetts' Secretary of Health and Human Services, Baker identified the expansion of coverage, the creation of health exchanges and cuts in Medicare as the "three big pieces" of ACA that would offer challenges and opportunities for social workers.

For example, expanded coverage would make more people eligible for care and treatment, he said, but also create potential dilemmas for what services can be provided, and in which form. Given this scenario, Baker strongly endorsed an emphasis on team-based approaches to health care issues, with specifically defined roles for each health care professional involved, and with measurement of outcomes built into the system.

Social workers would be a vital part of such cross-disciplinary work, he said, because their training tends to prepare them for a team-based approach better in comparison to other professions. "If everyone has a role, and if everyone plays a role, good things happen. This is a tremendous opportunity for all of you."

Baker said social workers and other health care professionals must endeavor to change a model in which 50 percent of health care dollars are spent by a "reasonably healthy" 95 percent of the population, and the remaining 50 percent by a five percent who "are really sick and pinball all over the system." He urged social workers to consider new, seemingly out-of-the-box solutions for longstanding problems, and to seek viewpoints from outside their profession – "people who don't see the elephant the same way you do."

Baker also said social workers should consider whether the culture of their particular organization or agency is attuned to problem-solving and team-based approaches. "Culture matters. Culture will crush strategy, always," he said.

His last piece of advice: "Trust your gut, but don't ignore data."

In his introduction to the panel discussion, McClain echoed Baker's call for social workers to assert themselves into reform. Social workers' training and education serve them well in other professions, he said, citing Under Secretary of State for Political Affairs Wendy Sherman, who holds an MSW degree and worked in the field before entering politics.

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