Last week, we wrote about the importance of determining the financial impact, in terms of return-on-investment (ROI), for payer and health plan investments in social services (see Social Services ROI Essential To Social Determinants Wave). This is an important step in moving the payment for social services from a “charitable act” to an investment in better consumer health and lower health care costs.
We outlined our recommended approach for measuring ROI for executives of provider organizations that are providing social service-integrated services for health plan consumers; however, there is no standardized process for this evaluation. That is apparent when you look at the early reporting of the financial impact of a variety of programs focused on social determinants of health—these are a few recent examples:
The “Newark Initiative”: Robert Wood Johnson Barnabas Health (RWJBH) & Horizon Blue Cross Blue Shield Of New Jersey (Horizon)—Horizon and RWJBH assembled a care team with a Horizon care transformation specialist, nurses, a personal health assistant, a health system-based social worker, and community health workers who all met with the identified Horizon members to learn about the non-medical barriers preventing the individuals from receiving care for their chronic health conditions. This care team worked to connect consumers to health care professionals and to non-medical resources provided by other community entities.
To measure the financial impact of this initiative, there were multiple measures, including total cost of care, hospital admissions, and use of emergency rooms. During its first year, a SDH pilot project in Newark cut the participants’ total cost of care by 25%, including 20% fewer hospital inpatient admissions, and 24% fewer emergency department visits (see New Jersey Horizon Blues Social Determinants Pilot Cut Total Cost Of Care By 25%).
HealthConnections: WellCare Health Plans—WellCare launched HealthConnections, a nationwide call center-based program for WellCare beneficiaries, in 2014 to provide free referrals to a network of local, community-based public assistance programs for support services. These social support service referrals included housing, transportation, food insecurity, and financial assistance for utilities. The program representatives tracked referrals and then followed up with beneficiaries to see if the social support referrals helped to meet their needs.
To measure the return from this program, a 2018 study measured the change in mean total health care expenditures in the year before and after a social service referral from the program. The study reviewed the WellCare claims data for beneficiaries who participated in the program over a two-year time period (claims data included all professional services, inpatient, outpatient, emergency department, and prescription drug services). Program representatives referred participants to social services, then followed up, typically within two weeks, to see if the participant reported that their social needs were met. Participants who reported that all their social needs were met had a reduction of 11% in total health care costs one year post-referral (see Expenditure Reductions Associated with a Social Service Referral Program).
The Better Health Through Housing Initiative: The University of Illinois & The Center For Housing & Health—University of Illinois Hospital & Health Sciences System (UI Health) and community-based housing organization, Center for Housing and Health, partnered in 2015 to develop a Housing First program targeted at chronically homeless consumers. In addition to UI Health, Northwestern Memorial Hospital, Rush University Medical Center, and Swedish Covenant Hospital also participate in the program, referring homeless consumers from their emergency rooms. After the consumer is accepted into the program, an outreach worker is sent into the community to contact the consumer and connect that consumer to the necessary housing services (see Better Health Through Housing: 218 Annual Report).
To measure the return from this program, UI Health examined overall health care costs and emergency room utilization. In the original pilot program, which included 27 consumers, UI Health found that after consumers had been placed in housing, health care costs fell 42% immediately. Follow-up assessments of the data shows that some consumers’ costs fell as much as 61% (see Case Study: University of Illinois Hospital & Health Sciences System’s Better Health Through Housing Program).
Hospital Nutrition Care Program: Advocate Health Care—Advocate Health Care launched a nutrition initiative in 2014. All consumers were screened at the point of hospital admission for malnutrition risk. Consumers identified as “at risk” received an oral nutritional supplement within 24 to 48 hours of admission. These same consumers also received inpatient nutrition education, post-discharge instructions, coupons for additional supplements, and follow-up telephone calls from the hospital call center personnel.
To measure the return from this program, studies examined average length of hospital stay and hospital readmission rates. Follow-up studies reported that the program reduced 30-day readmission rates by 27% compared to a control group baseline and reduced the average length of stay in hospital by almost two days when compared to a control group baseline. These reductions were used to calculate potential cost savings based on a model from the Center for Applied Value Analysis, a web-based budget impact model. Using this model, the reductions in readmissions and length of stay are estimated to produce a savings of $3,800 per consumer when compared to a control group baseline (see The Cost Of Malnutrition: Study Shows Nutrition Program Could Save Hospitals Up To $3,800 Per Patient).
These four studies illustrate the wide variety of social service interventions emerging in the market and the methodologies being utilized to measure their effectiveness. For more, check out resources in the OPEN MINDS Circle Library:
- Social Determinants Of Health & Medical Homes
- Social Determinants Of Health – How Housing & Other Social Support Services Influence Spending
- Tending To The Social Determinants Of Health – Or Not
- Poverty Really Does Matter When It Comes To Health Care Spending
- Helping Consumers With Food Insecurity: What Services Are Available?
- A Question Of Permanent Supportive Housing
- The Social Service Factor In The Health Care Value Equation
For more on building the relationships needed to operate under these kinds of evolving programs, join us on at The 2019 OPEN MINDS Strategy & Innovation Institute, where OPEN MINDS Senior Associate John F. Talbot will present, Taking Action On Social Determinants: New Social Support Models For Consumers With Complex Conditions, featuring Amber Rich, Community Partnership Specialist, Intermountain Healthcare; Angela Choberka, Community Partnership Specialist, Intermountain Healthcare; and Tracy Luoma, Executive Director, Optum Salt Lake County, Optum Consumer Solutions Group.