Cross-Sectional Analysis of Insurance Claims Shows Health Care Utilization and Costs Associated With Health-Related Social Needs (HRSNs) in an Urban Population.

Abstract

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.