Social determinants of health (SDOH) have long been recognized as having a significant impact on an individual’s health, well-being, and quality of life, HHLNssuch as housing instability or unhealthy living conditions, lack of public benefits, and threats to personal safety pose significant health risks. Frontline healthcare organizations increasingly understand the importance of addressing these needs, among patients is critical and they are implementing medical-legal partnerships (MLPs) to facilitate effective interventions. However, clinicians often lack tools within clinical workflows to screen patients for health-harming legal needs, proactively address these legal needs, and track patient outcomes. This program addresses these challenges, offering a blueprint for accurate identification of HHLNs, particularly among underserved populations, and integration into electronic health record (EHR) workflows.
“Mount Sinai was the first health system nationwide to establish a separate 501(c)(3) medical-legal partnership with MSMLP and this new program solidifies and builds on our commitment to innovation in addressing the health-harming legal needs of the patients we serve,” said Allison D. Charney, Executive Director of MSMLP. “It is a scalable, replicable, trackable, cost-efficient approach that transforms the delivery of civil legal services from the traditional reactionary, crisis-driven model to one that is preventative, proactive, and data driven. That creates the potential to achieve earlier, more impactful interventions that are life-changing for our patients.”
In addition to clinician referrals, the program utilizes data analytics developed by the Mount Sinai team to identify patients who are potentially facing HHLNs based on four key categories of legal risk: income maximization; immigration/naturalization; housing; and personal safety. Once the Mount Sinai analytics team has identified patients with potential legal risks, Mount Sinai care managers conduct screenings to confirm the patients’ legal needs and obtain consent to refer them to LegalHealth for an initial consultation and possible provision of free legal services, depending on the legal issues involved.
“Legal issues should never stand in the way of health. This program’s innovative approach is data-driven, collaborative, and preventative, aligning with the standard of care patients need to access legal services that can change the trajectory of their health and their lives,” said Randye Retkin, director of LegalHealth, a division of NYLAG. “Screening for patients’ legal needs directly within clinical workflows will enable our attorneys to connect more swiftly and effectively with those who often face the biggest barriers to health, wellbeing, and justice. This approach takes the medical-legal partnership to a new level and is a promising model for addressing inequities in health and access to legal services.”
“The program’s success relies on the legal services provider collaborating closely with the care coordinators, with the patients’ consent, making them an essential member of the interdisciplinary care team,” said Brooke E. Pennypacker, Director, Mount Sinai Health Partners.
“This collaborative approach is the pillar of the program in that it facilitates greater efficiency and effectiveness in screening, engagement, resource management, and access. As a result, our care coordinators can more rapidly respond to the urgent issues or barriers that are impacting our patients’ quality of life and support their broader medical, behavioral, and social care health goals.”
The program’s potential was demonstrated during a 12-month pilot which identified and provided free legal services to patients experiencing significant barriers to medical, behavioral, and social care services. The analytics tool identified 1,959 Mount Sinai patients with a potential unaddressed legal need, who were subsequently screened by care managers, resulting in 165 referrals and 157 patients consenting to legal assistance. Several patients had multiple unmet needs, resulting in 264 distinct legal matters being handled, 211 of which were resolved. The most common legal issues identified over the course of the pilot program were related to housing (41 percent) and income maintenance (35 percent). Of the patients who received legal assistance, 66 percent were over 45 years old, 73 percent were female, 56 percent were Hispanic, and 30 percent were Black.
“For too many people, unmet legal needs are a barrier to living a healthy life. To achieve health equity, the healthcare system needs a better understanding of how legal issues impact health outcomes,” said Susan Beane, MD, executive medical director, Healthfirst. “As we continue to gather data from this important partnership, it will help us understand how we might scale evidence-based models of care that incorporate legal services, so our members have access to the resources they need to be healthy. This kind of collaboration is consistent with the principles of Healthfirst ADVANCE, our commitment to health equity. Healthfirst is working to close health equity gaps for New York’s marginalized populations and providing a blueprint for others to join us in our mission within their own communities.”
“These results not only demonstrate the need for innovative, sustainable programs that accurately identify social and legal needs and strengthen integration across healthcare organizations but also how that need has been heightened by the COVID-19 pandemic, which has disproportionately impacted vulnerable New York communities,” said Robert Fields, Mount Sinai Chief Population Health Officer “The results also highlight the potential to scale and replicate this program to have a significant, positive impact on health equity for vulnerable patients and their communities, and to become programmatic through aligned value-based care. Mount Sinai is excited to be exploring that potential further with our program partners and to make our insights and this program available to other healthcare centers that share our mission to continue dismantling the barriers that contribute to poor health in the communities we serve.”
About the Mount Sinai Health System
The Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight hospitals, over 400 outpatient practices, over 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment.
About the Mount Sinai Medical Legal Partnership
Mount Sinai Medical Legal Partnership is an independent non-profit organization that provides vulnerable patients with free legal services to prevent and remedy the social and environmental conditions that are rooted in legal issues, such as housing, education, personal safety, and access to health care. The Partnership brings together lawyers and healthcare teams to implement integrated approaches and legal action that improve health and well-being of our communities.
About New York Legal Assistance Program (NYLAG)
Founded in 1990, New York Legal Assistance Group (NYLAG) is a leading civil legal services organization combatting economic, racial, and social injustice by advocating for people experiencing poverty or in crisis. Our services include comprehensive, free civil legal services, financial empowerment, impact litigation, policy advocacy, and community partnerships. NYLAG exists because wealth should not determine who has access to justice. We aim to disrupt systemic racism by serving individuals and families whose legal and financial crises are often rooted in racial inequality. NYLAG goes to where the need is, providing services in more than 150 community sites (e.g. courts, hospitals, libraries) and on our Mobile Legal Help Center. NYLAG impacted the lives of nearly 90,000 people last year. For more information, visit nylag.org.
Healthfirst is the largest not-for-profit health insurer in New York State earning the trust of 1.7 million members by ensuring access to affordable and high-quality healthcare. Sponsored by downstate New York’s leading hospital systems, Healthfirst’s unique advantage is rooted in its mission to put members first by partnering closely with its broad network of providers on shared goals. Healthfirst is also a pioneer of the value-based care model, now recognized as a national best practice. For nearly 30 years, Healthfirst has worked with its network of hospital systems, community providers, and partners to improve health outcomes and advance health equity through better access to care—especially in underserved communities adversely impacted by disease, health disparities and socioeconomic barriers to optimal health. Healthfirst has built its reputation in the community for top-quality products and services New Yorkers can depend on. It offers market-leading products to fit every life stage, including Medicaid plans, Medicare Advantage plans, Long-Term Care plans, Qualified Health plans, Essential Plans and individual and small group plans. Healthfirst serves members in New York City and on Long Island, as well as in Westchester, Rockland, Sullivan, and Orange counties. For more information on Healthfirst, please visit healthfirst.org.