How Social Prescribing Works

Social prescribing is a process through which a patient is referred to a non-medical, community-based activity, aligned with their needs and interests ("what matters to them"). Typically, socially-prescribed activities involve movement, nature, art, service, and belonging — pillars of health associated with improvements in health and wellbeing.

Depending on where the patient sees a health professional, what's available in their community, and how the activity is funded, social prescriptions can be used to treat a variety of conditions, including anxiety, depression, Type 2 diabetes, ADHD, chronic pain, substance use disorders, dementia, Parkinson's, heart disease, obesity, and more. It can also address lifestyle risk factors that precede medical conditions, such as stress, loneliness, and physical inactivity.

The formal internationally-agreed upon definition used to describe social prescribing is "a means for trusted individuals in clinical and community settings to identify that a person has non-medical, health-related social needs and to subsequently connect them to non-clinical supports and services within the community by co-producing a social prescription—a non-medical prescription, to improve health and well-being and to strengthen community connections."

Across many models, the social prescribing process is facilitated by a "link worker" — a professional who attempts to "link" the patient's interests to a community's offerings. While link workers are often non-clinical professionals, they can also include social workers, care navigators, community health workers, behavioral health coordinators, health coaches, nurses, school-based health workers or counselors, occupational therapists, or doctors themselves.

Instead of shorter appointments focused on addressing clinical needs, link workers generally have up to 60 minutes to get to know the patient's nonclinical needs, as well as their unique skills, interests, and life experiences ("what matters to them"). In some cases, the health-focused conversation with the link worker can be therapeutic in and of itself.

Beyond listening to patients and co-producing social prescriptions with them, the link worker supports patients to follow through with their socially-prescribed activities, sometimes even accompanying patients there, or arranging for someone who can accompany them. In some cases, link workers may also help track outcomes related to the social prescriptions, such as improvements in symptoms or reductions in healthcare usage. Given the number of critical duties assigned to the link worker, many healthcare systems have created a funded position for the link worker.

Most of the thirty-plus countries with social prescribing programs, such as the United Kingdom and Canada, have single-payer, government-run, taxpayer-funded health insurance systems. Unlike traditional fee-for-service models, these national health systems have shared incentives to prevent disease, improve population health, and ease pressure on clinical healthcare services, which are often limited. This is why such health systems tend to invest in interventions that address risk factors of chronic disease, such as stress, physical inactivity, and loneliness. They also tend to invest in interventions that ease pressure on healthcare, such as reduced emergency room visits, hospitalizations, and avoidable costs.

The United States, on the other hand, offers a mixed, multi-payer system, some of which have incentives resembling those of single-payer, government-run systems in the UK and Canada. For instance, programs within the Center for Medicare and Medicaid Services (CMS), including Medicare, Medicaid, Children's Health Insurance Plan (CHIP), and Federally Qualified Health Centers (FQHC), similarly aim to improve health outcomes and reduce costs. An estimated 2 in 5 Americans are covered by such CMS programs, and funding mechanisms such as Medicaid 1115 Waivers and HRSA grants may be used to cover the costs associated with social prescriptions.

Community health centers, nonprofit health plans, and the Veterans Administration (VA) health system have similar incentives to prevent disease, improve population health outcomes, and reduce unnecessary utilization of healthcare. These systems may also use government funding, as well as philanthropic dollars, to cover social prescribing costs.

Health maintenance organizations (HMOs), which typically pay physicians a fixed amount per patient per month in a capitation model (vs. services provided), also have an incentive to prevent disease, improve health, and reduce unnecessary utilization of healthcare and costs. Such systems offering value-based care are increasingly covering social prescriptions, with a pilot currently underway at Kaiser Permanente, one of the nation's largest HMOs.

Employees and universities may similarly include social prescribing as part of their wellness offerings, as a way to support overall productivity, retention, and wellbeing. For instance, Cornell, Stanford, Rutgers, and University of Michigan offer a variety of social prescribing programs.

In the meantime, some for-profit health systems are opting into social prescriptions, too. Private insurers, for instance, may be incentivized to differentiate their coverage from that of competitors. Horizon Blue Cross Blue Shield NJ was the first private insurer to cover art prescriptions. For-profit companies such as SocialRx (formerly Art Pharmacy) are working with additional insurers, both private and public across the fifty states and collecting data to strengthen the economic case for social prescriptions.

In terms of how providers are billing insurance for social prescriptions, one model does so through group medical visits, a practice in which health providers see patients in groups (usually of 8 to 15 people) instead of individually. Its success in improving clinical outcomes and generating shared savings over time has enabled such group visits to be billed through traditional insurance (under specific conditions).

Explore the science behind social prescribing in our searchable Research & Resources database. Learn about the movement, the people championing it, and the stories behind it in The Connection Cure by Julia Hotz — available wherever books are sold.

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