Social Determinants of Health Research in Health Affairs
By Kate Raphael
The February issue of Health Affairs featured many SDOH-related papers. Below we highlighted several of these that present evidence on the effectiveness of policies aimed at addressing health-related social needs and/or structural-level drivers of health. Read on for excerpts, and follow the links for the full read.
Horwitz et al, Health Affairs, February 2020
The degree to which US health systems are directly investing in community programs to address social determinants of health as opposed to screening and referral is uncertain.We searched for all public announcements of new programs involving direct financial investments in social determinants of health by US health systems from January 1, 2017, to November 30, 2019. We identified seventy-eight unique programs involving fifty-seven health systems that collectively included 917 hospitals. The programs involved at least $2.5 billion of health system funds, of which $1.6 billion in fifty-two programs was specifically committed to housing-focused interventions. Additional focus areas were employment (twenty-eight programs, $1.1 billion), education (fourteen programs, $476.4 million), food security (twenty-five programs, $294.2 million), social and community context (thirteen programs, $253.1 million), and transportation (six programs, $32 million). Health systems are making sizable investments in social determinants of health.
Murray et al., Health Affairs, February 2020
The ACOs with an emphasis on social services in our sample were struggling to address social determinants of health, despite serving populations with significant social needs and having leaders who recognize the importance of social determinants and facilitate the integration of social services and medical care. Only half of the ACOs had conducted standardized screening for social service needs, and fewer than half used standardized documentation. The majority used partnerships with community-based organizations to refer patients for social services.
Koh et al., Health Affairs, February 2020
This cohort study provides novel evidence of substantial differences in health care spending and use among a population whose members experienced episodes of homelessness and were attributed to a precursor ACO, compared to a similar Medicaid population without unstable housing. Average annual unadjusted total spending for people who experienced episodes of homelessness was 2.5 times greater than that among the comparison population. Unadjusted spending was 2.4 times greater for inpatient spending, 2.7 times greater for outpatient spending, and 2.2 times greater for prescription drug spending. Furthermore, health care spending in the BHCHP [Boston Health Care for the Homeless Program] population was roughly 3.3 times greater than the average national Medicaid spending per enrollee of $5,736 in 2014.
Ellen et al., Health Affairs, February 2020
We evaluated a recent renovation of public housing that was undertaken through the transfer of six housing developments from the New York City Housing Authority to a public-private partnership. We studied whether the renovation and transfer to private managers led to improvements in tenants’ health over three years, as measured by Medicaid claims. While we did not find significant improvements in individual health outcomes, we found significant relative improvements in overall disease burden when measured using an index of housing-sensitive conditions. These findings are not surprising. Given that broad-based housing renovations address a diverse set of health conditions, we should not expect them to have a significant impact on any single condition in the short run. Yet they may significantly improve residents’ overall well-being over time.
Kangovi et al., Health Affairs, February 2020
Interventions that address socioeconomic determinants of health are receiving considerable attention from policy makers and health care executives. The interest is fueled in part by expected returns on investment. However, many current estimates of returns on investment are likely overestimated, because they are based on pre-post study designs that are susceptible to regression to the mean. We present a return-on-investment analysis that is based on a randomized controlled trial of Individualized Management for Patient-Centered Targets (IMPaCT), a standardized community health worker intervention that addresses unmet social needs for disadvantaged people. We found that every dollar invested in the intervention would return $2.47 to an average Medicaid payer within the fiscal year.