Allison Stark

Introduction: Unmet health-related social needs (HRSNs) contribute to higher health care spending. Health systems and governments are increasingly addressing these needs to improve outcomes and reduce costs. Objective: This study examined differences in health care costs and utilization among patients who screened positive versus negative for HRSNs within a large urban health system. Methods: This retrospective, cross-sectional study included adult Medicaid patients (ages 21-65) who completed a 10-item HRSN screening between April 2018 and December 2019. Each patient’s first screening was linked to insurance claims for the following 12 months. Cost and utilization outcomes were analyzed using linear regressions adjusted for sociodemographic covariates. Results: Of 4432 patients, 1194 (26.9%) screened positive for at least 1 HRSN. Their mean annual health care cost was $8169.72, compared with $4393.22 among those without HRSNs, a difference of $3776.50 ( P < .005). Patients with HRSNs also had higher utilization: 3.65 more specialty visits, 1.08 more mental health visits, 0.86 more emergency visits, and 0.40 additional inpatient days annually ( P < .005). Conclusions: Unmet HRSNs were linked to significantly higher costs and utilization, highlighting the potential of addressing social needs to improve outcomes and reduce health care spending.

Previous research has demonstrated that social determinants of health are drivers of medical utilization, cost, and health outcomes. In this study, we compared the mean annual total cost to deliver health services per patient by health-related social need (HRSN) status and total HRSNs using linear regression and ANOVA, respectively. Patients with ≥1 HRSN (n = 8409) yielded $1772 higher annual costs compared to patients without HRSNs (n = 34 775) (P < .0001). Compared to patients without HRSNs, delivering care to patients with 1 HRSN (n = 4222) cost $1689 (P < .0001) more and to patients with ≥2 HRSN (n = 4187) cost $1856 (P < .0001) more per year.

BACKGROUND: Remote patient monitoring (RPM), which includes out-of-office blood pressure (BP) measurement, coupled with interventions including telehealth and team-based care, is recommended for hypertension (HTN) management. We aimed to assess participant experience with RPM for HTN (RPM-HTN) to understand barriers and facilitators to implementing RPM-HTN in a primary care population where health disparities and social inequities are prevalent. METHODS: This is a qualitative implementation study of participants’ experiences with an RPM-HTN program for primary care patients with uncontrolled HTN at an academic health system. We recruited participants with high and low levels of engagement (≥16 or <16 days of transmitted BP readings per month). Semi-structured interviews were conducted, and descriptive statistics and rapid qualitative analysis were used to identify factors affecting the implementation of RPM-HTN, specifically adoption, acceptability, appropriateness, and feasibility. RESULTS: Multiple themes emerged from interviews with 14 participants. A doctor’s recommendation and wanting help with BP management were facilitators for engagement, while work conflicts and forgetfulness were barriers to engagement. Participants enjoyed the format and content of nurse and clinical pharmacist phone calls and forming a relationship with the team; expressed improved understanding of HTN and BP management; and appreciated the convenience of remote monitoring. CONCLUSIONS: Participants found RPM-HTN acceptable and appropriate, highlighting the team-based and out-of-office approach to care. This study provides actionable targets to overcome feasibility barriers to implementation. In order to increase engagement, RPM policies and procedures should take into account barriers including the quantity of required BP measurements and mechanisms of telehealth communication.

Purpose Seriously ill patients in low-income and minority populations have lower rates of advance care planning. Initiatives that promote serious illness (SI) conversations in community health centers (CHCs) can reach broad, diverse patient populations. This qualitative study explored the experiences of primary care physicians in conducting SI conversations at CHCs in order to understand challenges and needs in this setting. Methods An initiative to increase SI conversations was implemented at two CHCs in the Bronx, NY. Eleven participating family physicians who together conducted 37 SI conversations underwent semi-structured in-depth interviews. The 11 interviews were analyzed using inductive thematic analysis. Results Eight themes emerged: (1) Structured approaches to SI conversations are useful even in longstanding patient-doctor relationships; (2) Discussion of prognosis is meaningful but difficult; (3) Emotional work is humanizing but draining; (4) Poverty and underinsurance are high priorities; (5) Social context affects patient readiness; (6) Communication barriers take multiple forms; (7) Patient characteristics make it “easier” or “harder” to initiate the SI conversation; (8) Time constraints limit the ability to meet multiple patient needs. Conclusions Physicians at CHCs identified challenges in SI conversations at personal, interpersonal, organizational, and societal levels. These challenges should be addressed by initiatives that aim to increase SI conversations in primary care, and especially at CHCs.