The implementation cost of a safety‐net hospital program addressing social needs in Atlanta
Open accessAbstract
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.
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The ROI of RPM depends on the specific clinical setting and available resources.
“The ROI of RPM depends on the specific clinical setting and available resources.7,24,25”
Data review is essential in RPM-HTN programs to facilitate successful home-based monitoring, aid patients in managing hypertension, administer antihypertensive medications, detect masked hypertension, and help avoid emergencies that could escalate to higher-acuity care.
“While meticulous, this process is essential in RPM-HTN programs to facilitate successful home-based monitoring, aid patients in managing hypertension, administer antihypertensive medications, detect masked hypertension, and help avoid emergencies that could escalate to higher-acuity care.24–27”
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“25 24 – 27 Previous research has shown that intervention protocols triggering patient-provider interactions on an as-needed basis, rather than at a standardized frequency, were associated with lower costs and greater effectiveness.”
Influential
- Authors
- MacLeod, K. E., Chapel, J. M., McCurdy, M., Minaya‐Junca, J., Wirth, D., Onwuanyi, A., & Lane, R. I.
- Affiliations
- Centers for Disease Control and Prevention (US)
- University of Southern California (US)
- Office of the Assistant Secretary for Planning and Evaluation (US)
- Grady Memorial Hospital (US)
- Corresponding author
- MacLeod, Kara E.
- Venue
- Health Services Research
- Publisher
- Wiley
- Published
- 2021-02-12
- Volume
- 56
- Issue
- 3
- Pages
- 474-485
- ISSN
- 0017-9124 (ISSN-L)
- 1475-6773
- PMC
- PMC8143691
- OpenAlex
- W3127059083
- Cited by
- 12
- References
- 53
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 3 · 2023: 1 · 2022: 2 · 2021: 1
- FWCI
- 1.34
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- public-domain
- onlinelibrary.wiley.com/termsAndConditions#vor (vor)
- Locations
- Health Services Research (publishedVersion)
- PubMed Central (publishedVersion, public-domain)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Health › Public Health and Social Inequalities
- Social Sciences › Health › Health disparities and outcomes
- Keywords
- social needs, safety-net hospitals, program costs, heart failure care, social determinants of health, health equity, community health workers, financial counseling, transportation barriers, medication adherence, home visits, health education
- MeSH terms
- Cross-Sectional Studies, Georgia, Health Education, Heart Failure, Home Care Services, Humans, Outpatient Clinics, Hospital, Retrospective Studies, Social Work, Socioeconomic Factors, Transportation, Disease Management, Medication Adherence, Safety-net Providers
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