- Implementing public programs to supplement food security in low-income patients can help reduce hospital use within that population, according to a study published in both BMC Geriatrics and Population Health Management. This data suggests that addressing the social determinants of health can directly improve health outcomes.
Currently, nearly one-third of senior patients live on income less than 200 percent of the poverty line, a fact which the Maryland-based research team said impacts that healthcare industry. Low-income patients have a higher propensity for utilizing hospitals and the emergency department.
Previous efforts to meet health needs include expanding access to primary care, but researchers added that caring for social needs is also essential for health improvement.
“Excess hospital utilization in this population was once believed to be preventable by improving health care access,” the research team said. “However, disparities exist among older adults who have health insurance through Medicare, and are not attributable to access to primary care providers.”
Previous research has suggested that 85 percent of patient health is determined by the social determinants of health, as opposed to genetic makeup or other health-related factors such as healthcare access.
The social determinants of health include social factors like housing, education level, and food security, among others.
The Supplemental Nutrition Assistance Program (SNAP) is one such program suitable for addressing food security. The federally-funded program has proven effective in expanding food access for low-income individuals, and shown that food access may be tied to health outcomes, the team posited.
“By targeting financial support toward food needs, SNAP can improve access to a higher quality diet for food insecure adults,” the researchers explained.
“There is evidence of reduced caloric intake, poorer dietary quality, and greater risk of hypoglycemia for low-income adults at the end of the month when funds run low,” the research team continued. “Therefore, greater SNAP benefits may facilitate chronic disease management for nutrition-sensitive conditions, which may account for evidence of reduced chronic disease hospital utilization.”
The team looked at nearly 6,900 patients over the age of 65 who were dually eligible for Medicare and Medicaid between 2009 and 2012. Matching data about days spent in the hospital, healthcare costs, and emergency department visits with SNAP enrollment data showed that the program has an impact on healthcare.
SNAP benefits reduced the likelihood for hospitalization by 14 percent, and reduced the likelihood of each individual day in the hospital by 10 percent.
The program also reduced the likelihood of nursing home admissions by 23 percent, and reduced each additional day in the nursing home by 8 percent.
SNAP benefits had no statistically significant effect on ED utilization, but the researchers maintained that the results nonetheless showed great potential for SNAP in healthcare.
Specifically, the results proved that more than just increasing access to care can help reduce hospital and ED utilization.
“It is notable that all had access to both Medicare and Medicaid because policy makers have increased access to health care for low-income groups thinking that that alone would reduce high hospital utilization in low-income groups,” the researchers pointed out.
It is indeed clear that access to healthcare can improve patient health, the researchers conceded. However, the study results show that the social determinants of health also play a role.
SNAP enrollment made a dent in healthcare costs, the researchers determined. Lowering hospital and nursing home utilization resulted in healthcare cost savings of nearly $19 million in 2012.
Expanding SNAP to all eligible individuals in 2012 would have cost about $39 million, meaning that half of the costs would have been recouped via healthcare savings.
Prominently, the study showed a needed policy change, the researchers said. Forty-two percent of Medicare patients included in the study were eligible for SNAP but were not enrolled for those benefits. Because of the health improvements SNAP can create, the researchers suggested a path forward for both healthcare organizations and health policymakers.
Both providers and policymakers should focus on identifying and intervening patients eligible for SNAP.
“Efforts to increase SNAP participation may include targeted eligibility screening and enrollment assistance,” the researchers said of individual practices. “Older adults tend to underutilize the program. Health care providers and health care payers can invest in efforts to screen for food insecurity and income eligibility for SNAP and facilitate SNAP enrollment.”
State policymakers can increase SNAP participation by reducing enrollment requirements, streamlining SNAP and other benefits program enrollment, and using Medicare and Medicaid data to screen for adults who are eligible for SNAP but have not yet enrolled.
Ultimately, these results prove that healthcare organizations that are addressing the social determinants of health are on the right track. While expanding access to care to underserved patients is an important task, it is not the only solution to improving healthcare. Addressing the upstream factors that influence health through institutional and policy-level actions can also have a benefit.
“These findings have public health implications because the majority of US older adults who are income eligible for SNAP do not participate,” the researchers concluded. “As public and private sector health care partners shift to outcomes-driven, value-based care, social service programs such as SNAP will be a critical tool in improving health outcomes for low-income seniors across the country.”