Impact of Social Needs Navigation on Utilization Among High Utilizers in a Large Integrated Health System: a Quasi-experimental Study

J Gen Intern Med. 2019 Nov;34(11):2382-2389. doi: 10.1007/s11606-019-05123-2.


Background: Programs addressing social determinants of health for high-utilizing patients are gaining interest among health systems as an avenue to promote health and decrease utilization.

Objective: To evaluate impacts of a social needs screening and navigation program for adult predicted high utilizers on total medical visit utilization.

Design: A prospective, quasi-experimental study using an intent-to-treat propensity-weighted difference-in-differences approach. Stratified analyses assessed intervention effects among three low-socioeconomic status sub-samples: patients in low-income areas, in low-education areas, and with Medicaid insurance.

Participants: Predicted high utilizers-patients predicted to be in the highest 1% for total utilization in a large integrated health system.

Intervention: A telephonic social needs screening and navigation program.

Main measures: Primary difference-in-difference analyses compared total visit count utilization, including outpatient, emergency department (ED), and inpatient utilization, between the intervention and control groups at both in-network and out-of-network facilities. Prevalence of social needs among sample patients and their connection rates to social needs resources are also described.

Key results: The study included 34,225 patients (7107 intervention, 27,118 control). Most (53%) patients screened reported social needs, but only a minority (10%) of those with a need were able to connect with resources to address these needs. Primary analysis found total utilization visits decreased 2.2% (95% CI - 4.5%, 0.1%; p = 0.058) in the intervention group. Stratified analyses showed decreases in total utilization for all low-socioeconomic status subgroups receiving the intervention compared with controls: - 7.0% (95% CI - 11.9%, - 1.9%; p = 0.008) in the low-income area group, - 11.5% (- 17.6%, 5.0%; p < 0.001) in the low-education area group, and - 12.1% (- 18.1%, - 5.6%; p < 0.001) in the Medicaid group.

Conclusions: Social needs navigation programs for high-utilizing patients may have modest effects on utilization for the population overall. However, significant decreases in utilization were found among low-socioeconomic status patients more likely to experience social needs.

Keywords: health care utilization; high utilizers; social determinants of health; social needs.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Delivery of Health Care, Integrated / statistics & numerical data*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Needs Assessment / statistics & numerical data
  • Non-Randomized Controlled Trials as Topic
  • Patient Navigation / organization & administration*
  • Prospective Studies
  • Social Determinants of Health*