Researchers examined four social needs screened at primary care practices: food insecurity, housing insecurity, transportation insecurity, and care coordination needs.
Significant resources would be required to address social needs and financing of interventions is mainly outside federal funding sources, according to a new research article.
Social needs such as housing, food security, and transportation can have a pivotal impact on the physical and mental health of patients. Unmet social needs are linked to health disparities, poor clinical outcomes, and health costs for several medical conditions.
The new research article, which was published by JAMA Internal Medicine, is based on data for patients who visited primary care practices. Four social needs were included in the analysis: food insecurity, housing insecurity, transportation insecurity, and care coordination needs. Primary care practices were divided into four categories: Federally Qualified Health Centers (FQHCs), non-FQHC practices in urban high-poverty areas, non-FQHC practices in rural high-poverty areas, and primary care practices in lower poverty areas.
The study features several key data points:
- Among patients with food insecurity, 95.6% of people were eligible for a federal assistance program but only 70.2% were enrolled
- Among patients with housing insecurity, 78.0% of people were eligible for a federal assistance program but only 24.0% were enrolled
- Among patients with transportation insecurity, only 26.3% were eligible for a federal assistance program
- Among patients with care coordination needs, only 5.7% were eligible for a federal assistance program
- The cost of conducting evidence-based interventions for food insecurity, housing insecurity, transportation insecurity, and care coordination needs averaged $60 per member per month, with primary care practice screening and referral management accounting for $5 of the cost and federal funding available for $27 of the cost
- Among patients who visited an FQHC, 31.9% were estimated to have food insecurity, 1.1% were estimated to have housing insecurity, 3.4% were estimated to have transportation insecurity, and 12.6% were estimated to have care coordination needs
- Among patients who visited primary care practices in lower poverty areas, 4.3% were estimated to have food insecurity, 0.2% were estimated to have housing insecurity, 2.2% were estimated to have transportation insecurity, and 9.4% were estimated to have care coordination needs
- The percentage of social needs costs paid by federal payers was 61.6% for food insecurity costs, 45.6% for housing insecurity costs, 27.8% for transportation insecurity costs, and 6.4% for care coordination costs
Federal financing is inadequate to cover most of the cost of social needs interventions, the study's co-authors wrote. "Food and housing interventions were limited by low enrollment among eligible people, whereas transportation and care coordination interventions were more limited by narrow eligibility criteria. Screening and referral management in primary care was a small expenditure relative to the cost of interventions to address social needs, and just under half of the costs of interventions were covered by existing federal funding mechanisms. These findings suggest that many resources are necessary to address social needs that fall largely outside of existing federal financing mechanisms."
Interpreting the data
More resources are needed to address social needs, the study's co-authors wrote. "We observed both low enrollment in existing programs, especially for food and housing interventions for which inadequate program capacity may limit participation of eligible people, and narrow eligibility criteria for existing transportation and care coordination interventions that excluded many in need. 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 healthcare-based screening."
Inadequate funding is a major barrier to addressing social needs, the study's co-authors wrote. "Our findings are consistent with national data on inadequate funding for housing or rental assistance. For example, among eligible households for the Section 8 Housing Choice Voucher Program, the nation's largest source of rental assistance, only 25% receive any rental assistance after an average wait time of approximately 2.5 years. Additionally, 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."
Many primary care practices face challenges in addressing unmet social needs, the study's co-authors wrote. "The cost of screening and referral management may be high relative to capitated primary care payments to a practice. The highest needs and highest costs for overall social interventions were among populations attributed to both FQHC and non-FQHC practices in high-poverty areas. While disproportionate funding was available to populations seen at FQHCs, the populations seen at non-FQHC practices in high-poverty areas were found to have larger funding gaps in terms of the intervention costs not borne by existing federal funding mechanisms."
Christopher Cheney is the CMO editor at HealthLeaders.
KEY TAKEAWAYS
The cost of conducting evidence-based interventions for food insecurity, housing insecurity, transportation insecurity, and care coordination needs averaged $60 per member per month.
Primary care practice screening and referral management accounted for $5 of the cost of interventions and federal funding was available for $27 of the cost.
The percentage of social needs costs paid by federal payers was 61.6% for food insecurity costs, 45.6% for housing insecurity costs, 27.8% for transportation insecurity costs, and 6.4% for care coordination costs.