Effects of a social health integration program on patient social needs, utilization, and cost outcomes in Kaiser Permanente Washington clinics

Abstract

As health care systems increasingly adopt social need screening and intervention activities, also known as social health integration (SHI), it is essential to understand the effect of these programs on patients’ social health and health system-level outcomes. Two Kaiser Permanente Washington implemented a pilot SHI program in which patients who reported social needs were randomized to receive support through one of two social health support programs: a clinic-based worker Community Resource Specialist (CRS) or a centralized Connections Call Center (CCC). This dissertation used data from EHRs, surveys, case notes, and claims for participants enrolled in Kaiser Permanente Washington’s pilot SHI program to understand the effects of a primary care-based SHI intervention on patient-reported social needs, and health system-level utilization and cost outcomes. The specific aims included: (1) assessing differences in resolution of need, defined by a reduced count of total social needs, over 5 months and between both social health support programs; (2) examining the effect of CRS, relative to CCC, on utilization outcomes over 9 months; and (3) examining effects of the SHI program on costs over 9 months in CRS compared to CCC. We found that there were no statistically significant differences in social needs resolution between CRS and CCC over time. We also found that CRS participants had higher primary care encounters and costs than CCC over 9 months. Our results from secondary analyses assessing differences between patients who received support from CRS relative to those who did not receive any assistance suggest that CRS support may lead to reduced social needs, and more engagement with the health care system through greater primary care visits, specialty care visits, and patient messages. These findings can inform health care systems in developing their SHI programs and understanding expected effects in response to these interventions.