NEW JAMA HEALTH FORUM PAPER: Federal Funding Cuts and Government Shutdown Threaten Valuable Advances in Integrated Clinical-Social Care Reports Authors From JHSON

Paper offers a way forward with policy and programmatic prescription.

WASHINGTON, Oct. 3, 2025 /PRNewswire/ -- A new paper in JAMA Health Forum highlights the danger of federal cuts to health care reforms that address patients' health-related social needs through integrated clinical-social care. In "Integrated Clinical–Social Care and Boundaries of Health Care" (Vincent Guilamo-Ramos; Marco Thimm-Kaiser; Adam Benzekri; Kody H. Kinsley), the authors also bring clarity to the debate about effective integrated clinical-social care with three spheres for policy and programmatic innovation.

"Medicaid cuts curb the progress made through integrated clinical and social care. A lack of shared vision of the value and role of integrated clinical-social care within healthcare reforms is also holding progress back. Our new paper advances this debate by delineating, and effectively leveraging the roles and functions of the health care system, social welfare system, and bridging infrastructure between them—to facilitate an integrated clinical-social care paradigm that improves health outcomes and reduces costs," said lead author Vincent Guilamo-Ramos, PhD, RN, FAAN, Institute for Policy Solutions (IPS) Executive Director and Leona B. Carpenter Chair in Health Equity and Social Determinants of Health at Johns Hopkins School of Nursing.

The new paper explores:

• Two contrasting conceptualizations of integrated clinical-social care. The first envisions social care as a set of billable add-on services layered onto existing clinical health care models—a status quo approach that has resulted in increased costs and inconsistent outcomes. The second represents a more transformative model: one that structurally aligns health and social welfare systems and prioritizes investment in infrastructure to coordinate services across the full continuum of patients' clinical and social needs.
  
  
• Optimizing population health through a transformative model of integrated clinical and social care requires improved coordination of three critical aspects of the overall healthcare delivery model:
  1) The Healthcare System: reimagined to focus on holistic prevention and health promotion, prioritization of primary care, and locationally flexible community-based care delivered in settings like community health centers, mobile health clinics, and homes. Integrated care should also emphasize multidisciplinary care teams made up of professionals like nurses, social workers, community health workers, and behavioral health specialists, and these teams should be culturally responsive and representative of the patients they care for. In this evolved health care system, interprofessional workforces can coordinate services that alleviate the health-related social needs that are proximally linked to health outcomes.
  2) The Social Welfare System: A strengthened safety net is essential to meaningful health care reform. While clinical care is critical, many of the factors that influence health—such as housing, food security, education, and transportation—lie outside the traditional health care system. These social determinants of health must be addressed through a robust social welfare infrastructure. By investing in this broader safety net, we can improve individual and community health outcomes, reduce costly health inequities, and build a healthier, more equitable nation;
  3) Bridging Infrastructure: Currently, the burden of navigating fragmented services falls on patients and communities, leading to delays, inefficiencies and poor outcomes. A more effective approach is to build a system that bridges effective care coordination infrastructure and strategic partnerships among hospitals and clinics, departments of health, social welfare organizations, and the patient communities being served. This would ensure continuity of services across a holistic set of health-related social needs, and optimal involvement of the sectors best positioned to impact positive outcomes.

"The health of our nation depends on expanding the traditional boundaries of care to fully integrate both clinical and social care needs," said Guilamo-Ramos. "The question is no longer if we should pursue integration, but how we can do so most effectively to consistently improve health outcomes and reduce unnecessary costs. Our healthcare system is in dire need of reform, and integrated care offers a clear path forward."

"Just imagine the possibilities of a redesigned health system—one that transcends traditional models of care to address every person's clinical and social needs," Guilamo-Ramos added. "Such a system would be transformative. It would be a true game changer." 

Link to JAMA Health Forum paper

Note to editors: For more information about IPS, please go to www.ipsnow.org.

SOURCE The Institute for Policy Solutions at Johns Hopkins School of Nursing