Staff and budgets spent on addressing social determinants of health (SDoH) is money well spent, according to a February 2020 study published in Health Affairs (HA). The study found that for every dollar spent on community health worker intervention to address unmet social needs in disadvantaged people yielded a $2.47 to an average Medicaid payer within a fiscal year.
According to the study authors, although there is abundant anecdotal evidence that SDoH strategies get results. However, the authors wrote that “with few exceptions, these programs have not been subjected to rigorous economic analysis.” While the study review did find two prior systematic SDoH reviews, the authors said the studies lacked adequate cost data and were hampered by study design flaws.
However, the HA study included 302 Pennsylvania patients, with 150 assigned to an intervention group. The cohort consisted of chronically ill, uninsured, or Medicaid-insured outpatients. The authors noted improvements in glycosylated hemoglobin, body mass index, tobacco cessation, mental health, and quality of care, and reduced hospitalizations. The improvements were accomplished by addressing upstream SDoH interventions. SDoH was defined as “the conditions in which people live and work—including income, social relationships, and education.”
Data Sharing Platform Critical
Once a patient was enrolled in the study, community health workers who were already employed by the social agency used a semi-formal interview structure to understand the patient’s life story and social needs. Patients then agreed upon a patient-driven action plan. Community workers relied upon an electronic message system to keep all of the patient’s social and clinical providers informed and in the loop. According to the study findings, a centralized data and information platform was vital in the study’s success.
The study relied on social security numbers and clinical feedback on all study participants. This included specific diagnosis-related groups (DRG) related to hospital admissions and discharge records. The study found that the 150 patients in the control group served by community workers incurred costs of $2.3 million, while the balance of the patients realized $3.7 million in hospital costs. Not only did the control group have fewer hospital admissions, but also less costly hospital admissions.
Hospitals Benefit from Partnerships with Social Service Agencies
Social service agencies such as those participating in the study provide real downstream benefits to health systems seeking to achieve value-based cost savings. Such whole-person care strategies are of great interest to hospitals seeking to make the transition from a fee-for-service payment model (episode-of-care volume-based care) to value-based reimbursement models (whole-person care). Yet, according to a 2018 paper in the American Journal of Managed Care, only about a third of hospital dedicated budget to SDoH solutions and only about a third of hospital electronic medical records screen for SDoH factors. By using a statically valid SDoH ROI calculation, the authors concluded:
“Although most agree that addressing high utilizers’ SDoH lead to better patient health, healthcare professionals often struggle to establish a concrete ROI for investing in SDoH software…(with a) ROI model and calculator…the financial impact of such an investment, (can) show (a) CFO how that investment can lead to reductions in readmissions from leading medical conditions and, ultimately, to cost savings for the hospital.”
Kaiser Permanente Makes a Big Investment in SDoH and Social Service Coordination
Kaiser Permanente announced in 2019 that, as the nation’s largest integrated health system, it would focus on several SDoH factors. These include housing and homelessness, food insecurity, and social services coordination. But it could be years before the benefit is documented, according to the project’s senior manager, so patience is in order.
“It takes a long time to change an individual and their behavior, so you can imagine changing a community is a long-term investment, not a short-term investment, so it’s going to take us a little while to see what the full benefits are,” David Grossman, MD, senior investigator and associate medical director for Kaiser Permanente Washington.