Making the Business Case for Social Needs Interventions — An Update

During the past three years, we have spoken with leaders of health care and community-based organizations interested in developing partnerships to address social determinants of health for the high-need, high-cost populations they serve. To do so, these leaders need information on what works and the expected impact from investments.

To help in these efforts, the Commonwealth Fund is publishing an updated evidence guide of 80 studies of social needs interventions for adults with complex health and social needs, specifically the impact on health care utilization and costs. The guide is organized into seven sections: housing, home modifications, nutrition, transportation, legal and financial counseling, social isolation and loneliness (new in this edition), and cross-cutting care management programs.

Our focus on health care utilization and cost impact for adults with complex needs is intended to help organizations make a business case for delivering social services. These data can be used as inputs for a Return on Investment (ROI) Calculator to inform program planning and in negotiating financially sustainable contractual relationships. In our work with the ROI Calculator, we learned that decision-makers often lacked benchmarks on program impact and costs, which inspired us to create the evidence guide as a companion resource.

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. More research is being produced in this area, with studies of increasing rigor. Supportive housing for chronically homeless and disabled individuals and nutrition interventions to address food insecurity have been studied extensively, as have care management programs that integrate health care and social services. Evidence on other social need interventions is still in an early stage of development.

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 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.

The evidence guide can help decision-makers consider how to align financial rewards among partners. For example, health care savings from reduced hospital utilization may not fully pay for supportive housing for people experiencing homelessness. But such programs can offer net societal benefit by reducing criminal justice system involvement and long-term care uses by people who otherwise would be institutionalized. Health plans may find it cost-effective to pay for the provision of supportive services in subsidized housing among enrolled populations such as dually eligible Medicare and Medicaid beneficiaries.

Payment, regulation, and market conditions must be aligned for cross-sector partnerships between health care and social service organizations to flourish. The Medicare and Medicaid programs are playing increasingly important roles in bringing attention to social determinants and health equity. Medicare Advantage plans can now include coverage for health-related social services, such as home-delivered meals and transportation to medical appointments, in supplemental benefit offerings. State Medicaid programs are being granted additional flexibility by the federal government to address social needs such as housing and home modifications. Health plans can pay for these and other community supports under the California Advancing and Innovating Medi-Cal initiative.

The evidence guide can be used in combination with the ROI Calculator to demonstrate the tangible value of investing and partnering with community and social service organizations to achieve shared goals in population health and health equity. We are encouraged by interest among policymakers, providers, payers, and researchers in evaluating how meeting the social and medical needs of individuals can improve their health outcomes and well-being while reducing the use of expensive health care services such as emergency department visits, hospitalizations, and institutional care.