Abstract
Recent health system innovations provide encouraging evidence that greater coordination of medical and social services can improve health outcomes and reduce healthcare expenditures. This study evaluated the savings associated with a managed care organization’s call center-based social service referral program that aimed to assist participants address their social needs, such as homelessness, transportation barriers, and food insecurity. The program evaluation linked social service referral data with healthcare claims to analyze expenditures in 2 annual periods, before and after the first social service referral. Secondary data analysis estimated the change in mean expenditures over 2 annual periods using generalized estimating equations regression analysis with the identity link. The study compared the change in mean healthcare expenditures for the second year for those reporting social needs met versus the group whose needs remained unmet. By comparing the difference between the first and second year mean expenditures for both groups, the study estimated the associated savings of social services, after controlling for group differences. These results showed that the decrease in second year mean expenditures for the group of participants who reported all of their social needs met was $2443 (10%) greater than the decrease in second year mean expenditures for the group who reported none of their social needs met, after controlling for group differences. Organizations that integrate medical and social services may thrive under policy initiatives that require financial accountability for the total well-being of patients.
Insights Results
Overview of article/model
This study evaluated the savings associated with a managed care organization’s (MCO) call center-based social service referral program that aimed to assist participants address their social needs, such as homelessness, transportation barriers, and food insecurity
HealthConnections model was developed by WellCare Plans, Inc. and connects participants with unmet needs to a call center-based program to obtain referrals to a nationwide network of local, community-based public assistance programs. The managed care organization representatives refer participants to social services, such as transportation, food programs, financial assistance for utilities, education programs, and housing services. HealthConnections employs a team of individuals responsible for identifying, collecting, maintaining, and analyzing the database of community-based social service organizations The call center is staffed with representatives who have personal experiences with the social service system, an approach that enables identification of the best match of services for participants’ unmet social needs. The program tracks each referral in the tracking database separately. Program representatives follow up with the participants to confirm whether the social services met their social need
Methods of article
This retrospective, secondary data analysis examined the association between met social needs (e.g., homelessness, transportation barriers, and food insecurity and health care expenditures). The study compared the change in mean health care expenditures for 2 groups of participants – all social needs met versus no social needs met – in the year before the social service referral and year after social service referral
The study sample included participants insured through Medicare Advantage or Medicaid managed care in 14 states who called WellCare’s HealthConnections program between January 1, 2015, and March 1, 2016 seeking referrals to a broad array of community-based public assistance programs, such as housing services and utility assistance
Results
Results demonstrated that of 2,718 participants in the analysis, 56% said their identified social needs were meet. The most commonly reported social need were medical transportation support (14.5%), utility financial assistance (12.1%), free or reduced dental services (6.1%), medication assistance (5.7%), general transportation support (4.2%), housing support (3.8%), and rent assistance (2.7%)
Results demonstrated that participants who reported all social needs were met experienced an 11% reduction in total health care expenditures in the 12 month post-referral period
Key takeaways/implications
Results reinforce the need for policies that encourage organizations to accept financial responsibility for addressing social determinants of health through nonmedical interventions
Study demonstrates that effective health care delivery may require interventions from a broad array of community-based organizations that act beyond the scope of the medical care provider
Authors suggest that future research should examine how investments in social service interventions can improve community health outcomes. Additionally, future analysis seeking to evaluate the relationship of each service type to healthcare expenditures may be warranted
Future investigation should analyze the impact of medical and social care integration on specific medical care service types
Future research could evaluate the impact of addressing social determinants of health on medical expenditures through an experimental design in which participants are randomly assigned to either the usual social service referral program or to an enhanced social service navigation aimed at assuring and independently confirming access to social services
Limitations to the study include: 1) Use of self-reporting of social service needs and whether or not those needs were met; 2) Number of patients not able to be contacted as follow-up; 3) Not accounting for potentially relevant unobserved covariates (e.g., education attainment, attitudes, social support) in social service needs and referrals in the program; 4) Lack of recording reasons why participants reported that their needs were not met; and 5) Inability to determine if savings realized by the MCO represent savings to the entire system
