Social Health Care that Delivers Results
Few things are more foundational than social stability.
Social dysfunction is the cause of community disruption and a first-tier driver of healthcare costs.
A detailed analysis¹ of social determinant effects on healthcare expenditures was published in the Journal of the American Medical Association (JAMA) in October 2024. There are essential things in their data that we don't think about enough.
One example is that having a high school diploma or GED is associated with a 60% reduction in annual Medicaid expenditures (95% CI, -3700.97 TO -789.80). This report is worth reading as it also covers Medicare and private insurance.
We need to ask ourselves, "Why do some social interventions produce measurable and sustainable results while others have difficulty?"
The backstory: We need to do a better job on the social side. Philanthropy group Arnold Ventures in 2018 wrote in "Straight Talk on Evidence,² ³"
"Reviewing thousands of evaluation studies over the years has given us a profound appreciation of how challenging it is to find interventions that produce a real improvement in people's lives."
Too many programs use rosy assumptions with little rigorous evaluation of actual results; at the same time, many programs with rigorous evaluations show no benefit.
This work is hard. Social systems are complex and unpredictable, and funding is limited. For these reasons, every project needs infrastructure to provide observations and processes that support the work, accurately report results to funders, and learn what to do better next time.
California's Whole Person Care Pilot is an example of a social intervention that successfully reduced healthcare costs.
The Whole Person Care (WPC) was pragmatic, purposeful, and supported by integrating infrastructure. This infrastructure is a force multiplier, making the achievement more straightforward, and the coalitions working together are better aligned using an unbiased connection to the change we want to make.
Here are some outcome facts from the UCLA Center for Health Policy Research⁴.
Parameters
Utilization changes per 1000 enrollees compared with the control group
Cost Savings: $383 in Medi-Cal payments per beneficiary per year, just short of annual savings of $95M per year in the managed group compared with controls⁵.
The Oregon Health Authority dashboard shows that Marion County had 139,176 people enrolled in OHP last month(November 2024). That is 39% of the county population. Marion County OHP population is more than half of the California intervention group (247,887), which saved almost $95M annually compared to controls.
California's treatment arm may have been at higher risk. Still, we have a similar population of homeless and substance users, and following this plan is likely to yield similar results—more care at a lower cost. This is certainly better than doing the same stuff that doesn't work year after year.
The bottom line: The WPC program achieved tangible outcomes through structured collaboration around shared goals. These results came from local community innovation that took advantage of a systems approach that made it easier through supporting technology.
Curandi's complex systems approach to support and technology is similar to California's.
By improving our social systems, we strengthen our society.
As California demonstrated, we can improve healthcare services while lowering costs.
¹ https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2825234
² https://straighttalkonevidence.org/2018/03/21/how-to-solve-u-s-social-problems-when-most-rigorous-program-evaluations-find-disappointing-effects-part-one-in-a-series/
³ https://straighttalkonevidence.org/2018/04/13/how-to-solve-u-s-social-problems-when-most-rigorous-program-evaluations-find-disappointing-effects-part-two-a-proposed-solution/
⁴ Pourat N, Chuang E, O’Masta B, Haley LA, Chen X, Zhou W, Haile M. Final Evaluation of California’s Whole Person Care (WPC) Program. Los Angeles, CA: UCLA Center for Health Policy Research, December 2022
⁵ https://healthpolicy.ucla.edu/our-work/publications/final-evaluation-californias-whole-person-care-wpc-program