The implementation cost of a safety‐net hospital program addressing social needs in Atlanta. (12th February 2021)

• Record Type: Journal Article
• Authors: MacLeod, Kara E.; Chapel, John M.; McCurdy, Matthew; Minaya‐Junca, Jasmin; Wirth, Diane; Onwuanyi, Anekwe; Lane, Rashon I.
• Is Part Of: Health services research. Volume 56:Number 3(2021)
• Page Start: 474
• Page End: 485
• Publication Date: 2021-02-12
• Subjects: costs and cost analysis -- evaluation study -- health equity -- hospitals -- social determinants of health -- uninsured/safety net providers; Medical care -- Periodicals; Medical care -- Evaluation -- Periodicals; Hospital care -- Periodicals; Health services administration -- Periodicals; 362
• DOI: 10.1111/1475-6773.13629
• Languages: English
• ISSNs: 0017-9124

Abstract

Abstract: Objective: To describe the cost of integrating social needs activities into a health care program that works toward health equity by addressing socioeconomic barriers. Data Sources/Study Setting: Costs for a heart failure health care program based in a safety‐net hospital were reported by program staff for the program year May 2018–April 2019. Additional data sources included hospital records, invoices, and staff survey. Study Design: We conducted a retrospective, cross‐sectional, case study of a program that includes health education, outpatient care, financial counseling and free medication; transportation and home services for those most in need; and connections to other social services. Program costs were summarized overall and for mutually exclusive categories: health care program (fixed and variable) and social needs activities. Data Collection: Program cost data were collected using a activity‐based, micro‐costing approach. In addition, we conducted a survey that was completed by key staff to understand time allocation. Principal Findings: Program costs were approximately $1.33 million, and the annual per patient cost was $1455. Thirty percent of the program costs was for social needs activities: 18% for 30‐day supply of medications and addressing socioeconomic barriers to medication adherence, 18% for mobile health services (outpatient home visits), 53% for navigating services through a financial counselor and community health worker, and 12% for transportation to visits and addressing transportation barriers. Most of the program costs were for personnel: 92% of the health care program fixed, 95% of the health care program variable, and 78% of social needs activities. Discussion: Historically, social and health care services are funded by different systems and have not been integrated. We estimate the cost of implementing social needs activities into a health care program. This work can inform implementation for hospitals attempting to address social determinants of health and social needs in their patient population.