More funding needed to address social health determinants: study

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Social needs, such as access to adequate food, housing, and transportation, are increasingly recognized for their importance in determining patients’ health outcomes. But primary care practices require far more financial assistance than they’re getting now to help patients address those needs.

That conclusion emerges from a study designed to estimate what it would cost for primary care practices serving high-poverty areas to adequately screen for and address their patients’ social needs. Using National Center for Health Statistics data on the social needs of 19,225 patients seen at primary care practices, the authors developed a model to estimate the numbers of people nationally with four domains of need: food, transportation, housing, and community-based care coordination services.

Practices in the study were categorized as federally qualified health centers (FQHCs), non-FQHC urban practices in high poverty areas, non-FQHC practices in high-poverty rural areas, and practices in low-poverty areas.

After analyzing the data, the researchers concluded that the cost of offering evidence-based interventions for the four domains averaged $60 per patient per month, which includes screening, navigation and enrollment, and ongoing delivery of interventions. However, only $27, or 45%, was federally funded. The highest needs, and costs, for overall social interventions were among practices—both FQHC and non-FQHC—in high-poverty areas.

The data also showed low enrollment across all four domains of need in assistance programs. For example, the authors estimated that 95.6% of those reporting food insecurity were eligible for at least one federal food support program, but only 70.2% were enrolled. Similarly, 78% of those with housing needs were program-eligible, but 24% were enrolled.

The reasons for eligibility-enrollment gaps differed, however. In the categories of food and housing interventions, the barrier was inadequate program capacity to meet the need. For transportation and care coordination interventions, narrow eligibility requirements excluded many of those who needed them.

“Our findings suggest the total costs of social needs interventions are far beyond what is typically allocated to programs for addressing health-related social needs, and this is particularly true for practices serving the neediest patients,” the author say. And payment models designed to address social needs do so by accounting for the additional care costs arising from those needs, rather than the cost of interventions for addressing those needs.

“These findings suggest that substantial resources would be needed to implement a comprehensive approach to addressing social needs that fall largely outside of existing federal financing mechanisms,” the authors conclude.

The study, “Estimated Costs of Interventing in Health-Related Social Needs Detected in Primary Care,” was published online May 30 in JAMA Internal Medicine