Health Leads Screening Toolkit Equips Providers to Take First Step in Addressing Patients’ Unmet Social Needs

First Screening Toolkit based on clinically-validated guidelines and range of patient-centered questions enables providers to gain critical insight into patients’ social needs like food, housing and utilities

BOSTON, Mass. – As hospitals and health systems across the U.S. continue to increase their commitment to addressing patients’ unmet social needs, Health Leads today launched the first in a series of Toolkits to arm health system leaders and front-line clinicians with guidance to integrate social needs interventions into medical care at scale. Combining insights from 20 years of experience implementing social needs programs in clinical settings with well-researched, clinically-validated guidelines from leading healthcare institutions, the Health Leads Screening Toolkit offers hospitals and health systems a user-friendly, comprehensive approach to effective social needs screening.

“Both payers and providers collect an immense amount of patient data across the country, yet when it comes to social needs – factors like access to healthy food, stable housing and transportation, which we know impact both outcomes and cost – we’re flying blind,” said Rocco Perla, Health Leads president. “By routinely screening patients and health plan members, we could take a giant leap forward in understanding the prevalence and impact of unmet social needs on the health system. Ultimately, marrying this screening data with claims, outcomes or utilization data could offer unprecedented insight into one of today’s leading healthcare challenges.”

Years of research on the social determinants of health have shown an undeniable connection between unmet social needs and poor health. Recent policy efforts to address social needs alongside medical care, including CMS’ Accountable Health Communities and Comprehensive Primary Care Plus initiatives, outline ambitious screening requirements and put additional pressure on providers to begin collecting social needs data. However, many providers are unsure where to start.

The Health Leads Screening Toolkit is the only toolkit to help providers screen for social needs prevalence with a patient-centered, multi-question approach based on clinically-validated guidelines from the Institute of Medicine, Centers for Medicare & Medicaid Services, Centers for Disease Control and Prevention and the Agency for Healthcare Research and Quality. It provides health systems and clinics with the information they need to customize their screening strategy based on the unique scope, goals and target population of their social needs programs. The Toolkit includes:

  • Essential social needs domains, representing the most common unmet social needs facing patients today;
  • Screening best practices, including guidance on question development, ease of use and clinical workflow integration;
  • Sample recommended screening tool, offering sample questions around the essential social needs domains;
  • Questions library, providing clinically-validated and patient-centered questions for each social needs domain, for a range of patient literacy

Updated annually, the Health Leads Screening Toolkit is available now as a free download at

Feedback and suggestions are welcome at

For an in-depth overview of the Screening Toolkit, join our webinar on Wednesday, September 14th, 2016 at 1:00 pm ET. To register, email



About Health Leads

Health Leads is a social enterprise that envisions a healthcare system that addresses all patients’ basic resource needs as a standard part of quality care. For 20 years, Health Leads has worked with leading healthcare organizations to tackle social co-morbidities by connecting patients to the community-based resources they need to be healthy – from food to transportation to healthcare benefits. Health Leads is committed to leveraging its tools, expertise and direct services to change what “counts” as healthcare – and accelerate the leadership, best practices, incentives and research required to improve the health and well-being of patients. Learn more at, reach us at and follow us on Twitter, Facebook and LinkedIn.

Media Contact Susan McCarron Health Leads 617-765-0142