Study Shows Social Risk Factors are Associated with Increased Healthcare Costs for Medicaid Beneficiaries

  • Published On  Nov 1, 2017


Study Shows Social Risk Factors are Associated with Increased Healthcare Costs for Medicaid Beneficiaries 

Healthcare costs $65 higher per month for beneficiaries who had trouble securing food, clothing or housing

CHICAGO – Social risk factors lead to an increase in healthcare cost and utilization even after controlling for past hospital utilization, chronic conditions, age and gender according to a paper published in the HSOA Journal of Community Medicine and Public Health Care. Beneficiaries who needed help securing food, clothing or housing had healthcare costs that were $65 higher per month than those who do not have these addressable risk factors.

“The need to understand high and rising risk Medicaid beneficiaries is becoming increasingly important as the Medicaid program continues to evolve. As a healthcare community, we need to be able to allocate care management resources in the most effective way with limited resources while ensuring our patients receive the best care,” said Dr. Art Jones, chief medical officer, Medical Home Network.

Many managed care networks do not systematically collect social and behavioral risk factors in a medical setting. However Medical Home Network (MHN) has implemented one of the largest applications of a social risk assessment among a population of newly eligible ACA Medicaid beneficiaries. MHN designed a five-minute risk assessment tool that questions new beneficiaries about health and social risk factors and past emergency department utilization.

“Medical Home Network’s goal was to identify addressable social risk factors in addition to medical issues and prove the predictive value of having care managers address these issues and help prevent those ‘rising risk’ beneficiaries from becoming an even higher cost,” said Christy Lemak, PhD, chair, Health Services Administration at the University of Alabama and the study’s evaluator and author.

The purpose of the study was to explore how medical and social risk factors impact use and spending using Medical Home Network ACO medical and pharmacy claims, medical and social risk assessment information and patient enrollment data from 7,762 Medicaid beneficiaries, who were continuously enrolled twelve months after completing the assessment.

“Medical Home Network determined managed care networks should screen for social factors to manage long-term healthcare costs,” Dr. Art Jones said.

Medical Home Network uses results reported on the risk assessment to allocate care management resources. They deploy a multi-disciplinary, team-based approach that includes care management staff. Each primary care practice collaborates with community partners to address and attempt to resolve the individual’s self-identified barriers to care.

“Our results showed us there is more to a patient than their medical history. Social risk factors allow us to learn more about the patient beyond the clinic walls and as a result we are able to implement a more holistic approach to patient care,” said Beth McDowell, manager of medical analytics, Medical Home Network.


The title of the study published in HSOA Journal of Community Medicine and Public Health Care is “Predictive Value of Screening for Addressable Social Risk Factors” authored by Art Jones, MD; Christy Harris Lemak, PhD; Cheryl Lulias; Todd Burkard; Beth McDowell and Kylie Severson.

About Medical Home Network

Medical Home Network is transforming health care delivery for Medicaid patients by fostering collaboration and innovation. Our proven model of care unites communities of providers and patients around a common goal: To redesign health care delivery and transform the way care is delivered and managed, resulting in improved patient care, lower costs and better health in the communities we serve.