Volume 56 | Number 3 | June 2021

Abstract List

Kara E. MacLeod DrPH, John M. Chapel BS, Matthew McCurdy MPH, Jasmin Minaya‐Junca MPH, Diane Wirth ANP‐BC, CACP, Anekwe Onwuanyi MD, Rashon I. Lane MA


To describe the cost of integrating social needs activities into a health care program that works toward health equity by addressing socioeconomic barriers.

Data Sources/Study Setting

Costs for a heart failure health care program based in a safety‐net hospital were reported by program staff for the program year May 2018–April 2019. Additional data sources included hospital records, invoices, and staff survey.

Study Design

We conducted a retrospective, cross‐sectional, case study of a program that includes health education, outpatient care, financial counseling and free medication; transportation and home services for those most in need; and connections to other social services. Program costs were summarized overall and for mutually exclusive categories: health care program (fixed and variable) and social needs activities.

Data Collection

Program cost data were collected using a activity‐based, micro‐costing approach. In addition, we conducted a survey that was completed by key staff to understand time allocation.

Principal Findings

Program costs were approximately $1.33 million, and the annual per patient cost was $1455. Thirty percent of the program costs was for social needs activities: 18% for 30‐day supply of medications and addressing socioeconomic barriers to medication adherence, 18% for mobile health services (outpatient home visits), 53% for navigating services through a financial counselor and community health worker, and 12% for transportation to visits and addressing transportation barriers. Most of the program costs were for personnel: 92% of the health care program fixed, 95% of the health care program variable, and 78% of social needs activities.


Historically, social and health care services are funded by different systems and have not been integrated. We estimate the cost of implementing social needs activities into a health care program. This work can inform implementation for hospitals attempting to address social determinants of health and social needs in their patient population.