Advancing Primary Care



Funding Area

Advancing Primary Care


January 2019


This NYSHealth issue brief explores the results of a study by Maimonides Medical Center to identify which social services have the greatest impact on health and cost outcomes.

Under a 2013 grant, NYSHealth awarded Maimonides Medical Center a grant to assess the costs and benefits of social services and to incorporate them into a comprehensive total cost of care model. However, New York State’s adoption of Health and Recovery Plans (HARPs) vacated the need for the project’s initial premise. Recognizing the need to make smart investments in social services for patients, Maimonides redesigned the project. The project team studied a sample of 600 patients engaged in at least nine months of consistent care management through the Brooklyn Health Home program. They collected first-hand patient data to assess the extent to which social services with a demonstrated impact on health influenced health care outcomes, as well as to identify the best opportunities for future investments in social services.