Addressing health-related social needs costs about $60 per patient each month

Key takeaways:

• Many interventions for social needs are not covered by federal funding.
• Although 95.6% of individuals with food insecurity were eligible for federally funded programs, only 24% were enrolled.

Researchers estimated that the cost of evidence-based interventions that address health-related social needs in primary care practices is about $60 per patient per month.

The results suggest that “substantial resources” are needed to address social needs, which often sit outside federal funding mechanisms, Sanjay Basu, MD, PhD, the head of clinical at Waymark, a California-based company that seeks to improve health care access and outcomes for people on Medicaid, and colleagues wrote in JAMA Internal Medicine.

Unmet social needs like food, transportation and housing insecurity have frequently been associated with negative physical and mental health outcomes, as well as greater financial expenditures.

However, when considering implementing programs within health care to identify and target these socioeconomic disparities, “there may be inadequate capacity to address the needs once identified — a problem known as the bridge to nowhere,” Basu and colleagues wrote.

The researchers added that “how best to finance such interventions remains a major, unaddressed question.”

“Understanding the resource landscape (ie, what interventions are available to address needs), existing financing mechanisms to pay for such interventions, and gaps in financing that would need to be filled is crucial for planning major changes to health care delivery,” they wrote.

To estimate the costs of implementing interventions for social needs, Basu and colleagues conducted a decision analytical microsimulation of 251,406,318 primary care patients (45.7% men; mean age, 34 years) using 2015 to 2018 data from the National Health and Nutrition Examination Survey and the National Center for Health Statistics.

Among the simulated population, Basu and colleagues reported that:

• 17.5% had moderate to severe food insecurity;
• 0.9% had severe housing insecurity;
• 2.8% had transportation insecurity; and
• 12.7% were eligible for community-based care coordination.

While 78% and 95.6% of people with housing and food needs were eligible for federally funded programs, only 24% and 70.2% were enrolled, respectively.

In addition, there were low enrollment numbers among people eligible for transportation programs (26.3%) and care coordination needs (5.7%), of whom only 1.4% and 2.2% were enrolled, respectively.

The cost of providing evidence-based interventions averaged $60 (95% CI, $55-$65) per member per month, and included:

• $5 for screenings and referral management in clinics;
• $38 for food insecurity interventions;
• $7 for housing security interventions;
• $0.2 for transportation insecurity; and
• $9 for community-based care coordination.

Of the total cost per month, the researchers estimated that $27 (95% CI, $24-$31) was federally funded, while $33 (95% CI, $30-$35) “would be required to expand interventions to address those not eligible or eligible but not enrolled.”

"This suggests that major changes to the way social services are delivered in the U.S. may be needed if we are to respond appropriately to needs identified through health care-based screening,” they wrote.

The researchers also noted that the lower costs of screening and referrals compared with the other interventions “suggests that health care organizations may have a lower financial barrier to screening and referring patients to social services, while community-based or public-sector agencies may have greater barriers to financing necessary interventions on referral — exacerbating the ‘bridge to nowhere’ problem of inadequate community-based capacity to address social needs identified by health care systems.”

“Nevertheless, the cost of screening and referral management may be high relative to capitated primary care payments to a practice,” they wrote.

Basu and colleagues concluded that future research is needed to update simulations with newer data and “also consider how the costs for investment in social needs interventions contrast with potential savings in terms of return on investment from improved health and potentially lower health care costs.”