Building the Actionable Business Case for Private Payer and Provider Investments in Social Services


An emerging body of evidence suggests that when patients have access to needed social services, they have better health outcomes, have fewer emergency department visits, and incur lower medical costs. Some studies indicate that up to 40 percent of patients’ improved health outcomes can be attributed to social and economic factors rather than to medical care. For high-need, high-cost patients, there is an opportunity to promote investments in social services that can simultaneously improve their experiences while reducing spending for the payers and provider organizations that serve them. This project aims to develop up to three business cases for payer and provider investment in social services for high-need, high-cost patients. KPMG will conduct a literature review and then structured interviews with approximately 17 payer and 17 provider organizations, including accountable care organizations and integrated delivery systems, to see how social services are perceived and to investigate the barriers to investment in them. Following an advisory group meeting convened by KPMG, project staff, in collaboration with The Commonwealth Fund, will select up to three social services for further analysis. These might include housing support, nutrition assistance, or nonemergency transportation. For each service, the KPMG team will create a model detailing the resources and financial investment necessary to administer the service. Each business case will include a discussion of the potential benefits in terms of decreased spending, reduced staff turnover, and improved patient experience. KPMG will collect feedback from payers and provider organizations and test the business cases. This project will yield practical guidance for risk-based payers and providers, illustrating for them the potential quantitative and qualitative returns of investing in specific social service interventions.

Grant Details

Grantee Organization:
Principal Investigator:
David Hansell, J.D.
Award Amount:
Approval Date:
July 13, 2016

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