SDOH Interventions Cost Average $60 Per Patient, Federal Aid Falls Short

While more primary care practices are screening patients for social risk, the cost of social determinants of health (SDOH) interventions targeting housing security, non-emergency medical transportation, and community-based care coordination surpasses available federal funding by over half.

According to researchers from the study published in JAMA Internal Medicine, the lack of federal support leaves the majority of these SDOH interventions as unfunded needs, with uncertain sources for the remaining funding.

"Deploying SDOH interventions, such as arranging rideshares to medical appointments and connecting individuals to food pantries or affordable housing complexes, holds the potential to reduce hospital inpatient admission rates and emergency department visits,” the researchers wrote.

However, the question remains: How can these SDOH interventions be effectively implemented, researchers queried.

"We know that unmet health-related social needs are associated with health disparities and poor clinical outcomes," said Sanjay Basu, MD, PhD, a senior author of the study. "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." 

Using data on 19,225 patients' social needs, collected by the National Center for Health Statistics between 2015 and 2018, researchers examined the cost of evidence-based interventions in the domains of food, housing, transportation, and care coordination assistance.

SDOH interventions across these four areas averaged $60 per member per month, with $5 dedicated solely to screening and referral management within clinics. Of the total cost, $27 (45.8 percent) was federally funded.

"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 Bruce Landon, MD, 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."

Notably, while funding disparities existed for populations served at FQHCs, non-FQHC practices in high-poverty areas faced more substantial funding gaps. In other words, there’s a bigger disparity in how much SDOH interventions cost non-FQHCs and how much federal funding they get.

"Jack Geiger was famous for saying that, in medical school, he learned that the best prescription for hunger was food," said Robert Phillips, MD, MSPH of the Center for Professionalism and Value in Health Care. "This study should support payers in giving clinicians a new prescription pad that costs $2.17 per patient per day—less than the cost of a cup of coffee."

Despite the potential return-on-investment SDOH interventions can offer, healthcare providers face challenges in funding them, Landon stated.

Previous research has shown that connecting homeless individuals with complex medical needs to supportive or transitional housing can reduce healthcare costs, including lower emergency department visits, hospital readmissions, and lengths of stay. However, given the narrow financial margins within healthcare, finding sustainable funding for these interventions remains a barrier and a long-term concern.

Additionally, the researchers found that only a fraction of those in need benefit from SDOH interventions, as just 24 percent of eligible individuals with housing needs and 70 percent with food security needs are enrolled in the programs.

Gaps persist across various SDOH interventions. For individuals with transportation needs, only 26 percent were eligible for transportation programs, while just 6 percent of those with care coordination needs qualified for care coordination programs.

“Not only are existing programs to address health-related social needs underused, but many people with these needs are not eligible for them," said Seth A. Berkowitz, MD, MPH of the University of North Carolina at Chapel Hill. "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."