Implementation and costs of a food insecurity resource navigation program for primary care patients with diabetes and hypertension in South Carolina

OBJECTIVE: To examine food insecurity resource navigation program costs and how navigation intensity relates to clinical outcomes, healthcare costs, and quality of life (QOL) for diabetes and/or hypertension patients. 

METHODS: This retrospective study included patients receiving resource navigation (July 12, 2021-December 31, 2022 with twelve-month follow-up) across three primary care practices in South Carolina's largest health system. Participants were 18+ years old (from electronic medical records/Epic), had food insecurity (from Hunger Vital Sign™), and diabetes and/or hypertension (from Epic registries). Matched controls came from food insecurity screening-only practices. Patients in each group (n = 219) had diabetes (9.13%), hypertension (50.23%), or both (40.64%). Navigation, fixed resources, and training costs were estimated using micro-costing from a US hospital system perspective (2025 USD). Multivariable models examined associations between outcomes (HbA1c, blood pressure, body mass index, primary, emergency, and inpatient charges, QOL), and navigation frequency, and duration, controlling for age, gender, race/ethnicity, payer, and comorbidities. 

RESULTS: Program costs (total = $29,752.91) primarily included case reviews ($19,809.25), navigation ($5,068.67), and training ($1,975.84), averaging $135.86 per patient. Navigation intensity was associated with twelve-month changes in HbA1c, BMI, QOL, primary, and inpatient charges. 

CONCLUSIONS: Navigation programs incur significant personnel time costs. Individuals with great healthcare needs may require intensive navigation.