Providing Legal Services in Clinical Settings Can Help Promote Health Equity, According to New Research in Health Affairs

As health care organizations seek to address unmet social needs of their patients to improve health care quality, equity, and health outcomes, medical-legal partnership offers a practical intervention to address social and environmental circumstances of patients that have a remedy in civil law. More than 300 health care organizations nationwide have adopted medical-legal partnerships in a wide variety of settings, including general hospitals and health systems, children’s hospitals, health centers, veteran’s health clinics, tribal health organizations, and others.

In a new commentary published in Health Affairs today, “Addressing Social Determinants of Health Through Medical-Legal Partnerships,” Marsha Regenstein and a research team from the National Center for Medical Legal Partnership at the George Washington University Milken Institute School of Public Health’s Department of Health Policy and Management identify eight core components of medical-legal partnership and three major organizational models that health care organizations employ to address their patients’ unmet social needs through these arrangements. Key elements of partnerships identified by the researchers include the use of training to bridge clinicians understanding of when legal help is best deployed, and the presence of lawyers on-site in the clinical setting to help legal staff better understand the challenges patients face. The intervention is highly flexible and can be tailored to address the needs of unique patient populations.

The researchers drew on national survey findings and field research, including site visits and dozens of interviews with health care and legal professionals, to identify the ways in which medical-legal partnerships are successfully integrating civil legal services into clinical care to address intractable problems that patients face—including barriers to stable housing, education and employment, and health insurance—to improve health equity.

Innovative funding arrangements for civil legal services are emerging for such partnerships. For example, several states have recently launched pilots to incorporate legal services into Medicaid payment rates. To scale and spread this intervention properly, medical-legal partnerships need more sustainable funding. The authors also highlighted the need to better align this intervention with other social determinant of health clinical initiatives, and for practical guidance on how to target scarce medical-legal partnership resources.

This commentary appears in the March 2018 issue of Health Affairs, which focuses on advancing health equity. Others authors are Jennifer Trott, Alanna Williamson, and Joanna Theiss.