Investing in Social Determinants of Health Yields High ROI

A community health program that tackles socioeconomic determinants of health saved Medicaid roughly $1.4 million, a new study unveiled Monday in the journal Health Affairs has found. The study marks one of the first return-on-investment analyses of just how valuable community-health workers and social-focused health approached truly are.

As part of the economic analysis study, University of Pennsylvania researchers conducted a randomized, controlled trial that included 302 Individualized Management for Patient-Centered Targets (IMPaCT) patients. The study calculates ROI for the program from the perspective of a Medicaid payer.

IMPaCT is a community health worker intervention program that addresses socioeconomic and behavioral barriers to health in low-income populations by providing support for high-risk patients.


In general, social determinants of health have become a focal point within the U.S. health care system, as the industry has begun to recognize the ways socioeconomic and environmental factors impact differences in health status.

This is partly due to the health care system beginning to embrace more value-based care models over time, according to Shreya Kangovi, an associate professor at the University of Pennsylvania and one of the study’s authors.

“We are gradually moving from a sick care system towards a health care system, where we pay health systems based on whether or not they’re able to keep patients healthy,” Kangovi told Home Health Care News. “When you think about what it takes to keep people healthy and what makes people sick, that’s where social determinants of health come in.”


Overall, researchers found a team of community health workers saved Medicaid $1.4 million — an ROI of $2.47 for every dollar invested in social determinants of health.

“The overall cost savings was pretty significant,” Kangovi said. “The program only costs $500,670 for one team of community health workers — and that same team saved Medicaid $1.4 million.”

Furthermore, when researchers conducted an analysis that varied the number of admissions and outpatient visits attributable to IMPaCT, the return still ranged from $1.84 to $3.09.

“Any time you do an economic analysis, it’s always good to ask, ‘How robust is this?’” Kangovi said. “If we varied a few things, does that change the outcome significantly? It turns out, even when assuming a worse-case scenario, it still had a positive return on investment.”

Researchers note that IMPaCT is a well-structured program and not every social determinant or community-health program will automatically yield the same results, according to Kangovi.

“It’s a positive message, but also a reminder that we have to get this right,” she said.

As far as in-home care’s place in all of this, Kangovi believes that these services have an instrumental role to play.

“Here at Penn Medicine, we have a direct-care program,” she said. “Penn Medicine At Home has been a terrific organization. Community health workers are often in homes and communities, often working alongside home health aides, nurses, PTs and OTs that go into the home. [Home health] complements a people-centered skill-set with a clinical skill-set.”

Senior Helpers is one home-based care organization that has committed itself to social determinants of health. In 2019, the company implemented the Life, Independence, Function, Evaluation (LIFE) Profile — a data-driven assessment tool to enhance its care planning and document “micro-social determinants of health.”

Alliance Homecare is another such organization. Last year, the company began offering food delivery through its partnership with Epicured, a subscription meal-delivery service.

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