The total cost for offering evidence-based interventions to address social determinants of health is significantly higher than the federal funding available for these types of programs, a new study found.
The study, published in JAMA Internal Medicine, discovered that the cost of providing evidence-based solutions for food, housing, transportation and care coordination is $60 per member per month on average. Existing federal funding covers $27 per member per month, less than half of the total cost.
“We know that unmet health-related social needs are associated with health disparities and poor clinical outcomes,” said Dr. Sanjay Basu, a senior author for the study and co-founder and head of clinical at Waymark, in a news release. “But we’ve historically lacked an understanding of how much to adjust payments to account for social risk factors. This research fills an important gap for both policymakers and payers evaluating how much additional funding is required to address patients’ health-related social needs.”
The analysis relied on data of 19,225 patients gathered by the National Center for Health Statistics from 2015 through 2018. The primary care practices included in the study were federally qualified health centers (FQHCs), non-FQHC urban practices in high poverty areas, non-FQHC rural practices in high poverty areas and practices in lower poverty areas.
Most of the people with food and housing needs were eligible for federally funded programs, the study found. However, many were not enrolled, partially because of a lack of capacity in the programs. About 78% of people with housing needs were eligible for federally funded programs, but only 24% were enrolled. In addition, 95.6% of people with food needs were eligible, but only 70.2% were enrolled.
When it came to transportation and care coordination needs, strict eligibility criteria (such as missing medical appointments due to a lack of transportation or having chronic conditions) led to low enrollment. Just 26.3% of those with transportation needs were eligible for federally-funded programs, and only 5.7% of those with care coordination needs were eligible.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
“Not only are existing programs to address health-related social needs underused, but many people with these needs are not eligible for them,” said Dr. Seth A. Berkowitz of the University of North Carolina at Chapel Hill and co-author of the study, in a statement. “It’s not just a question of navigating people into programs that already exist — we need new programs that can address the social context that is making people sick.”
In addition, the study found that offering universal screenings for social determinants of health factors in primary care practices costs $5 per member per month.
“Although this is far lower than the costs of delivering services, it still represents a substantial cost to primary care practices, which are already underfunded and under tremendous pressure,” said Dr. Bruce Landon, co-author and MBA of Harvard Medical School. “These findings suggest that more funding needs to be directed to primary care to support the implementation of more robust, comprehensive screening.”
Photo: vaeenma, Getty Images
