Differences in health care costs between two social health support programs: Findings from a randomized social health integration pilot program

Introduction: More health systems are implementing strategies to understand and address patient social health, also known as social health integration. We examine the impact of a pilot social health integration program in two primary care clinics in an integrated health care system on health care costs.

Methods: We randomized 534 patients who reported any social need between October 2022 - January 2023 to receive support from a centralized Connections Call Center (CCC) or clinic-based Community Resource Specialists (CRS). We used administrative and claims data to compare costs between programs incurred by the health care system over 9 months. Using an intent-to-treat approach, we used two-part models to estimate costs for behavioral health, emergency department, inpatient admissions, and urgent care. We estimated single-part models using generalized linear models for primary care, specialty care, and total costs. Our secondary as-treated analyses compared costs among those who received support from CRS to those who did not.

Results: Unadjusted results showed no significant differences between CRS and CCC participants. Adjusted findings showed that CRS participants had $286 higher primary care costs than CCC participants (95% CI: $63.61, $508.89). As-treated findings showed that those who received CRS assistance had $2,356 more specialty care costs (95% CI: $229, $4,482) than those who did not.

Conclusions: Observed changes in primary and specialty care costs may be a result of increasing engagement with the health system that could support patients in managing their health and prevent avoidable utilization in the long-term. These findings can help inform others who are interested in adopting similar primary care interventions.