Financial Assistance Programs May Improve Cardiovascular Health

A recent study shows that patients enrolled in a program to improve socioeconomic factors that affect health showed significant improvements in key cardiovascular risks. This program, run by the non-profit Health Leads, helps connect patients with local services to fulfill their unmet socioeconomic needs.

"We know that unmet basic resource needs for things like nutritious food, housing, transportation and medication are very common and are associated with poor health outcomes," said Seth A. Berkowitz, MD, MPH, corresponding author of the report. "We've offered the Health Leads program at several of our internal medicine practices for the past few years, but we did not yet know whether this strategy for addressing patient’s unmet needs would lead to changes in clinical outcomes."

These interventions were seen to improve blood pressure and cholesterol levels in the patients enrolled, according to a study published by JAMA Internal Medicine.

The study is a follow-up to previously published research that screened patients for unmet social needs through a survey, and referred the patients to healthcare advocates at Health Leads. These patients were then linked to local services that helped assist with the patients’ various healthcare and overall needs. With a duration of 7 months, the original study was not long enough to determine the clinical effects, which is what the current study was designed to do.

Patients receiving primary care through certain providers from 2013 to 2015 were surveyed about their desire to receive financial assistance for healthy food, prescription drugs, or bills. They were also asked about their interest in finding employment or receiving housing assistance.

More than 5000 patients were screened, of whom 1774 reported having at least 1 unmet need, according to the study. There were 1021 patients who enrolled in the Health Leads program to satisfy their unmet needs.

These patients were found more likely to be minorities, have less than a high school education, have a primary language that was not English, and have health insurance through Medicaid. Individuals who participated in the program were typically contacted by the program’s advocates 5 times, and each case was open for an average of 6 weeks, the authors reported.

Approximately 60% of patients who enrolled in the program indicated that their needs had been met or they no longer required assistance. Another 35% of cases were considered to be unsuccessful, with more than 93% of those cases resulting from a loss of response to their advocates, according to the study.

The researchers conducted a review of the medical records for all patients who were screened, including those who did not enroll in the Health Leads program. They discovered that patients with hypertension who enrolled in the program had a more significant reduction in blood pressure compared with those who did not.

Patients who enrolled in the program also had a significant improvement in LDL cholesterol levels, but there was no significant difference in HbA1c levels among patients who did and did not enroll in the Health Leads program.

"While we don't know why there was no effect on blood sugar levels for participants with diabetes, improving dietary quality is probably the most important factor for improving HbA1c," said Dr Berkowitz. "It's possible that the resources people can be linked to for food are not as robust as are those assisting with medication, which is more important for blood pressure and cholesterol control. We do plan future studies to determine whether the program can be modified to better address blood sugar control and, eventually, whether these risk factor improvements actually reduce cardiovascular events."

These findings suggest that implementing more programs similar to Health Leads could potentially help patients achieve positive health outcomes and drive down healthcare costs, the authors concluded.

“This study is one of the first to draw a positive association between social needs interventions and clinical outcomes and illuminates the potential impact of these programs across the health system on quality, cost and health,” said Rocco Perla, president of Health Leads. “Dr. Berkowitz and MGH [Massachusetts General Hospital] are among a growing group of leading, forward-thinking researchers who are building the much-needed evidence base around social needs interventions, and Health Leads is committed to supporting these efforts.”