Which Social Determinants of Health Interventions Yield Best ROI?

Social determinants of health interventions focused on housing security, including addressing houselessness and making home modifications to improve housing quality, improve clinical outcomes and generate a return on investment, according to an analysis from the Commonwealth Fund.

The analysis, published as a follow-up to a similar three-year-old document, found moderate evidence that social determinants of health interventions centered on food, nutrition, and transportation were effective.

Meanwhile, more data is needed to support the efficacy of medical-legal partnerships and interventions for social isolation and loneliness. Although there has been rigorous study looking at care management or patient navigators, results are mixed, the researchers said.

“Overall, we continue to see mounting evidence that addressing social needs of complex patients can reduce costly forms of health care utilization and result in savings,” the researchers wrote in a blog post accompanying the report. “More research is being produced in this area, with studies of increasing rigor.”

The issue of social determinants of health has seen mounting recognition over the past decade as the medical industry has begun to embrace value-based reimbursement models. Experts have asserted that addressing social determinants of health will stem the upstream factors that impact patient well-being, particularly patient access to preventive care and chronic disease management.

But in order to justify investments in social determinants of health interventions—which can range from footing the bill for rideshares to medical appointments to referral to food pantries to building affordable housing complexes—organizations have needed to assess the value of these interventions.

The Commonwealth Fund guide outlines the current literature examining social determinants of health interventions tailored to different social challenges, including housing security, housing quality, nutrition, transportation, care management, medical-legal partnerships, and social isolation and loneliness.

The guide describes literature as being strong (leaning on randomized control trials), moderate (non-randomized trials and observational studies comparing two groups), and promising (pre/post and descriptive studies comparing two groups).

The evidence for housing-related interventions was the strongest, the researchers said. The literature review found that connecting homeless people with complex medical needs with supportive or transitional housing can reduce expensive healthcare. That means lower emergency department visit rates, lower hospital readmission rates, fewer hospital days, shorter hospital length of stay, and overall lower healthcare costs.

Studies about home modifications also showed that the interventions are effective. One study looking at modifications for older adults to prevent falls showed considerable return on investment; modifications cost just shy of $3,000 but prevented nearly $20,000 in healthcare costs.

Modifications to improve home cleanliness and reduce asthma triggers yielded between 103 and 258 percent ROI.

Nutrition-focused interventions showed promising and moderate evidence. Research has shown that home-delivered meals can reduce ED visits, inpatient admissions, 30-day readmissions, hospital length of stay, SNF admissions, and overall medical costs. Medically tailored meals yield higher ROI than non-tailored meals, data showed.

Meanwhile, non-delivered food support programs like SNAP were effective for chronically ill, low-income, or otherwise food-insecure people. Non-delivery programs proved especially successful at reducing hospitalizations and ED visits.

Other social determinants of health interventions had weaker evidence. Although strong evidence proved that non-emergency medical transportation improves patient access to care, there’s negligible data indicating NEMT actually cuts healthcare costs.

And although studies about medical-legal partnerships showed these interventions can realize nearly 149 percent ROI, the research lacks comparison groups, so the Commonwealth Fund could only categorize that literature as promising.

For care management programs, which use healthcare navigators to screen for and coordinate referral to healthcare and social care, the data is a mixed bag. Although some studies have indicated that patient navigation is can reduce healthcare costs, others have found limited results.

And for studies regarding social isolation and loneliness, the Commonwealth Fund found some good evidence but few programs with good design. One program used meal delivery to help increase social contacts, which the Commonwealth Fund said indicated the utility of addressing social isolation as a part of other social determinants of health interventions.

Understanding how different social determinants of health interventions work and the current literature surrounding them is key for organizations making investment decisions. Most healthcare experts agree that addressing social determinants of health is important for improving outcomes and reducing costs.

“Holistically addressing social and medical needs can improve health outcomes and may produce health care savings as well, by reducing use of expensive health care services such as emergency department visits, hospitalizations, and nursing home stays,” the Commonwealth Fund wrote in the report’s introduction.

But the healthcare industry is defined by its tight margins. Identifying the ROI for certain interventions is critical as organizations make strategic decisions. The Commonwealth Fund said it intended its guide to be used in tandem with its ROI Calculator to help organizations determine how programs can work together to support patients in a financially feasible way.

That said, the Commonwealth Fund experts emphasized the human impact that SDOH interventions can have.

“Calculating financial impact for defined populations does not mean that social need interventions should be undertaken only when they yield a positive ROI for the health care sector,” the report authors asserted in the accompanying blog post. “The human impact on access to services, health outcomes, and economic opportunity can justify the investment to meet community benefit and health equity goals. Even so, it is useful to know the financial impact.”