Dive Brief:

  • Programs focused on social determinants of health for Medicaid beneficiaries might reduce unnecessary healthcare use, but might also end up costing health systems more than they save in the long run, according to new research published Tuesday in the Annals of Internal Medicine.
  • Researchers analyzed how a case management program for patients in California impacted healthcare utilization and costs, and found those enrolled had fewer inpatient hospitalizations and emergency department visits than those not enrolled.
  • But program expenses were nearly $22.4 million in 2019, and savings — about $3.4 million annually — covered just 17% of the program’s cost, according to the report.

Dive Insight:

Healthcare organizations in recent years have increased their focus on social determinants of health, or the way a patient’s lifestyle and access to needed resources can influence their health and how much money is spent on their medical care.

From 2017 to 2019, hospitals spent $2.5 billion on programs focused on offering patients help finding housing, employment, education, food and other resources, according to a 2020 study published in Health Affairs.

Health disparities became even more pertinent during the pandemic as COVID-19 has disproportionately claimed the lives of people of color and those in underserved communities.

The Annals of Internal Medicine study looked at California-based Contra Costa Health Services’ CommunityConnect case management program, using data from 57,972 adult Medicaid beneficiaries patients either enrolled in the program or not enrolled in the program.

Those who enrolled and accepted services met with a case manager to evaluate their social needs, addressing concerns around food, transportation, housing, finances, employment, social support and any unmet medical needs.

Case managers then helped patients develop goals and a plan to achieve them, helping them apply for public benefits, find referrals to social services, connect them with other healthcare providers and offer other resources.

Enrolled patients were offered 12 months of social needs case management. Medical use was measured through emergency department visits and inpatient hospital admissions between the two groups, with some visits considered avoidable.

Ultimately, the program helped reduce total inpatient admissions by 11% and total emergency department visits by 4%, according to the study.

Among different age groups, the youngest patients enrolled in the program saw the greatest reduction in healthcare utilization. Less of an impact was seen among older patients.

Among different racial groups, Black patients enrolled in the program saw the largest reduction in inpatient admissions.

Only 40% of those enrolled in the program actually engaged with it, however, and the program was in continual development during the course of the study, researchers wrote.

The study estimated the population-level impact of offering such services to Medicaid beneficiaries. Systems considering whether to build out their own SDOH programs are likely interested in that impact, “although a more precise understanding of effects on patients who accept services could help guide decisions on targeting and outreach,” researchers wrote.

The findings also suggest such programs may help with managing patients’ chronic conditions. Case managers said in their feedback that it helped patients build trust with the healthcare system and better understand the landscape while resolving basic social needs, according to the report.

The program was effective in lessening healthcare use among those enrolled, but the reductions weren’t big enough to make up for the cost of implementing it, the study ultimately found.

In 2019, program expenses were $22.36 million, with 70% spent on personnel, 25% on IT expenses and contracts and 5% on supplies.

Estimating emergency department visits at $705 per person and inpatient hospitalizations at $14,989 per person, the program helped save $3.42 million in its first year, the study found.

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Social needs program for Medicaid beneficiaries can be effective but costly, research finds – Healthcare Dive