The direct clinic-level cost of the implementation and use of a protocol to assess and address social needs in diverse community health center primary care clinical settings

Purpose. Social determinants of health, including food insecurity, housing insta-bility, social isolation, and unemployment are important drivers of health outcomes and utilization. To inform implementation of social needs screening and response protocols, there is a need to identify the associated costs in routine primary care encounters. Meth-ods. We interviewed key stakeholders in four diverse community health centers that had adopted a widely used social needs screening and response protocol. We evaluated costs using an activity-based costing tool across both the initial implementation phase and ongoing maintenance phase. Results. Clinic costs were associated with workforce devel-opment, planning, and electronic health record integration. These initial implementation costs varied by site ($6,644–$49,087). On a per-patient basis, ongoing maintenance costs ranged from $9.76 to $47.98. Conclusion. Our findings can aid in designing reimburse-ment mechanisms tied to social needs screening and response to accelerate translational efforts and promote health equity.

Duke Scholars

Author Connor David Drake Population Health Sciences

Author David Edward Edelman Medicine, General Internal Medicine