Implementing social risk screening and referral protocols in a healthcare system: Attitudes, barriers, and successes

ACOs and SSOs included data sharing difficulties, lack of standard ACO-SSO financial contracts, and frequent state budget changes.SSOs reported payment challenges (e.g., delayed reimbursements) and administrative burden.ACOs reported communication challenges with SSOs and burdensome state reporting requirements.Implementation facilitators included state funding to build SSO infrastructure for Flex administration, data sharing tools, and routine ACO-SSO communication. Conclusion:Approximately 1-in-6 Flex-eligible ACO members were enrolled in Flex services over 3 years.Health system partnerships with community-based SSOs should consider personalizing nutrition services, implementing standardized financial contracts and data-sharing platforms, funding administrative infrastructure, and facilitating cross-sector communication.