There is a tremendous amount of focus on the value of social interventions like housing and food stability, on the cost of healthcare. For the benefit of all, we must learn how to investigate the value of these interventions.
A recent study in Health Affairs by Kangovi et al. examines the return on investment for an evidenced-based community health worker program that addresses unmet social needs. Furthermore, they state that there is a return of $2.47 for every dollar invested in a Medicaid population within one-years’ time.
What is more important than the results is the conversation concerning how to address such questions. First, the findings highlight the importance of identifying interventions that show the effectiveness and do not extrapolate that other models will deliver similar results. Also, their study involves a design that includes a theory-based approach, then emphasizes personalized action plans with hands-on support. This method is vital as it focuses on the activation of the human being while simultaneously delivering identified needed help. This approach is different from numerous other situations, which focus much more on “screen-and-refer,” thus missing the engagement component.
Secondly, they discuss the need for a study design that identifies the financial value that is more encompassing than just those predicted to be high cost. It suggests incorporating multiple metrics to determine the correct population in which to intervene. Third, it is imperative to address the financial returns for those that are funding the intervention. This problem is a significant issue when we tend to focus on a solution that has long-term implications but defines the ROI for a much shorter period. This need is due to how we finance healthcare and the fact that the long-term beneficiary is not always the institution that provides the investment.
Finally, for the reasons indicated above, we tend to ignore the most important return which is the effect on our society as a whole. One could argue if we included this factor, regardless of who pays for the intervention, as long as we all do it, all investors would benefit over time.
As we mature in our present models, we must also expand our thinking on how to define success and the value of our interventions. Not only is it imperative to study whether a model is pertinent, but it also behooves us to understand how to study the actual financial impact, both for the investor and the entire ecosystem. Thus, it is wise to include a value-chain component to our thinking in our model designs in addition to defining success. Furthermore, we have limited resources so being diligent is required for us to understand how to invest best. Only through a scientific approach will we be able to identify what works and what does not. Thus, we must adjust our study methodologies to encompass a different model of intervention.