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The implementation cost of a safety‐net hospital program addressing social needs in Atlanta
Author(s) -
MacLeod Kara E.,
Chapel John M.,
McCurdy Matthew,
MinayaJunca Jasmin,
Wirth Diane,
Onwuanyi Anekwe,
Lane Rashon I.
Publication year - 2021
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.13629
Subject(s) - safety net , health care , program evaluation , medicine , socioeconomic status , nursing , ambulatory care , business , family medicine , environmental health , population , public administration , political science , economics , economic growth
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.