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Identifying and Addressing Patients’ Social Needs in Health Care Delivery Settings

This chapter describes both patient- and community-level risk assessment tools and provides a framework for existing intervention models. It also highlights emerging payment models that may facilitate health care delivery-based social and economic needs screening and interventions, and underscore outstanding knowledge gaps in this rapidly evolving field. In response to mounting evidence that patients' social and economic risk factors affect health and could be important targets for reducing health care costs, a wave of health care innovation has emerged around identifying and addressing patients' social needs as part of clinical care delivery. Future work is needed, however, to explore the workforce needed to support social health screening and intervention programs, the role of technology, and policy and payment reforms needed.