Hospitals across the United States are finding that investments in social services such as housing assistance and food programs not only improve patient health but also reduce costs and boost their financial performance. The shift represents a fundamental change in how healthcare institutions approach patient care, moving beyond traditional medical treatment to address the underlying social factors that drive poor health outcomes and expensive emergency room visits.
Major health systems from North Carolina to California have documented substantial returns on these investments. The programs target patients whose medical conditions are complicated by homelessness, food insecurity, or unstable housing. By connecting these patients with social services, hospitals are reducing readmissions, cutting emergency department use, and improving their bottom lines while simultaneously addressing some of the most persistent health disparities in American medicine.
Health Systems Document Cost Savings From Social Interventions
Atrium Health, one of the largest healthcare systems in the Southeast, has measured concrete financial benefits from its programs addressing social determinants of health. The Charlotte-based system, which operates more than 40 hospitals across North Carolina, South Carolina, Georgia, and Alabama, invested in screening patients for social needs and connecting them with community resources.
The health system found that patients who received help with housing, food, and transportation had 17 percent fewer emergency department visits and 11 percent fewer hospital admissions compared to similar patients who did not receive such assistance. These reductions translated into approximately $2,300 in savings per patient over a 12-month period, according to data the system shared with healthcare industry publications.
Kaiser Permanente, the integrated health system serving more than 12 million members, has taken the approach further by directly investing in affordable housing development. The Oakland-based organization committed $200 million to address housing insecurity among its members and the broader communities it serves. The investment includes funding for affordable housing construction, homelessness prevention programs, and support for community health centers in low-income neighborhoods.
The organization's internal analysis showed that members experiencing housing instability had healthcare costs that were 40 percent higher than those with stable housing. Emergency department visits were twice as frequent, and hospital admissions for conditions that could have been managed in outpatient settings were three times more common. By addressing housing needs, Kaiser Permanente projected it could reduce these excess costs while improving health outcomes for thousands of members.
ProMedica, a health system based in Toledo, Ohio, purchased a food bank and grocery stores in underserved neighborhoods as part of its strategy to address food insecurity. The system's analysis revealed that patients with diabetes who received food assistance had better blood sugar control and required fewer emergency interventions. Hospital admissions for diabetes-related complications dropped by 40 percent among program participants, while emergency department visits fell by 50 percent.
Academic Research Confirms Return on Investment
The financial case for addressing social needs has gained support from rigorous academic studies. Research published in Health Affairs, a leading peer-reviewed journal focusing on health policy, examined programs at multiple hospitals and found consistent evidence of cost savings.
A study analyzing data from more than 3,000 patients at five hospitals found that those who received assistance with housing, food, and other social needs had 24 percent lower total healthcare costs over a two-year period compared to a control group. The reduction came primarily from fewer emergency department visits and hospital readmissions. The study calculated that for every dollar spent on social interventions, hospitals saved approximately $2.50 in medical costs.
The research identified several mechanisms through which social interventions reduce costs. Patients with stable housing are more likely to attend follow-up appointments and take medications as prescribed. Those with adequate food are better able to manage chronic conditions such as diabetes and heart disease. Access to transportation reduces missed appointments and delays in seeking care that can lead to medical crises.
Another study published in JAMA Network Open examined a housing intervention program for homeless patients with chronic medical conditions. The program provided supportive housing along with case management services. Researchers tracked healthcare utilization for 18 months and found that hospital admissions decreased by 57 percent and emergency department visits fell by 61 percent among program participants. Total healthcare costs dropped by an average of $6,300 per person per year.
The New England Journal of Medicine published research showing that screening for social needs and connecting patients with community resources improved outcomes for patients with multiple chronic conditions. The study followed more than 1,000 patients at urban safety-net hospitals. Those who received social services referrals had fewer complications, better medication adherence, and lower rates of preventable hospitalizations. The intervention cost approximately $400 per patient but generated savings of $1,800 per patient through reduced acute care utilization.
Insurance Companies and Government Programs Expand Coverage
The evidence of financial returns has prompted health insurance companies and government programs to begin covering social services as part of medical benefits. This shift creates new revenue streams for hospitals and healthcare organizations that provide these services.
Several state Medicaid programs have received federal approval to use Medicaid funds to pay for housing support, food assistance, and other social services for eligible beneficiaries. North Carolina's Medicaid program launched Healthy Opportunities Pilots in selected counties, providing up to $650 million over five years for non-medical services including housing, food, transportation, and interpersonal safety. The program allows healthcare organizations to bill Medicaid for connecting patients with these services and for the services themselves.
Early results from the North Carolina pilots showed promising outcomes. Participants had 12 percent fewer emergency department visits and 8 percent fewer inpatient admissions in the first year. Healthcare providers participating in the program reported that the Medicaid payments covered their costs for screening, referral, and follow-up services, making the programs financially sustainable.
CareOregon, a Medicaid managed care plan serving more than 400,000 members, has covered housing support services for several years. The plan pays for move-in assistance, housing deposits, and short-term rent support for members experiencing homelessness or housing instability. An analysis of the program found that members who received housing assistance had 38 percent lower total healthcare costs compared to similar members who did not receive such help. The plan spent an average of $2,400 per member on housing services but saved approximately $6,000 per member in reduced medical costs.
Private insurance companies have also begun pilot programs. Humana, which provides coverage for more than 17 million people, launched a program in several markets to address food insecurity among members with diabetes and heart disease. The company delivers medically tailored meals to eligible members and provides nutrition counseling. Internal data showed that program participants had fewer hospital admissions and better management of chronic conditions. Humana calculated that the program generated a positive return on investment within 18 months.
UnitedHealthcare, the largest private health insurer in the country, expanded its housing support programs after documenting cost savings. The company works with community organizations to provide housing navigation services, rental assistance, and supportive housing for members with complex medical needs. An analysis of more than 2,000 program participants found that emergency department visits dropped by 43 percent and inpatient admissions fell by 35 percent. The company reported that medical cost savings exceeded program costs by a ratio of approximately 3 to 1.
Community Partnerships Enable Broader Reach
Healthcare organizations are increasingly recognizing that addressing social determinants of health requires collaboration with community-based organizations that have deep expertise in housing, food security, and social services. These partnerships allow hospitals to leverage existing community infrastructure rather than building parallel systems from scratch.
Boston Medical Center established a partnership with Greater Boston Food Bank to operate a food pantry within the hospital. The program serves patients identified through screening as experiencing food insecurity. Patients receive immediate access to nutritious food and are connected with longer-term food assistance programs in their communities. The hospital reported that patients using the food pantry had improved management of chronic conditions and fewer emergency visits for complications related to inadequate nutrition.
Hennepin Healthcare in Minneapolis developed a comprehensive partnership network with more than 50 community organizations providing housing, food, transportation, and other social services. The hospital created a centralized referral system that screens patients for social needs and connects them directly with appropriate community resources. Care coordinators follow up to ensure patients successfully access services and to address any barriers that arise.
The system tracked outcomes for more than 5,000 patients referred to community partners over a two-year period. Those who successfully connected with social services had 28 percent fewer emergency department visits and 19 percent fewer hospital admissions compared to patients with similar needs who did not complete referrals. The hospital calculated that the partnership network generated approximately $4 million in cost savings while improving care for vulnerable populations.
Advocate Aurora Health, a large health system operating in Illinois and Wisconsin, invested in building the capacity of community organizations to serve patients with complex social needs. The system provided grants, technical assistance, and training to dozens of local nonprofits, helping them expand services and develop systems for sharing data with healthcare providers. This approach strengthened the overall social services infrastructure in the communities the health system serves.
The investment yielded benefits beyond individual patient outcomes. By strengthening community organizations, the health system created more robust referral networks that could serve larger numbers of patients. The approach also built trust between healthcare institutions and community groups, facilitating more effective collaboration on addressing social determinants of health.
Technology Platforms Streamline Referrals and Tracking
The growth of programs addressing social needs has spurred development of technology platforms designed to connect patients with community resources and track outcomes. These systems help healthcare organizations manage referrals, coordinate with community partners, and document the impact of social interventions.
Several health systems have implemented platforms that allow clinicians to screen patients for social needs using standardized tools, generate referrals to appropriate community organizations, and track whether patients successfully access services. The systems create closed-loop referrals, meaning healthcare providers receive feedback on whether patients connected with resources and what services they received.
This technology infrastructure addresses a longstanding challenge in connecting patients with social services. Previously, referrals often consisted of giving patients lists of phone numbers or addresses with no follow-up on whether they successfully accessed help. The new platforms create accountability and allow healthcare organizations to identify barriers that prevent patients from accessing services.
Data from these platforms also enables healthcare organizations to measure the impact of social interventions on health outcomes and costs. By linking social services data with medical records, hospitals can analyze which interventions are most effective for different patient populations and conditions. This evidence base supports continued investment and helps refine program design.
The platforms have also revealed gaps in community resources. When many patients are referred for a particular service but few successfully access it, that signals insufficient capacity or barriers to access. Healthcare organizations have used this information to target investments in expanding community services where needs are greatest.
What This Means
The financial benefits hospitals are documenting from social service programs represent more than isolated success stories. They signal a structural shift in how the healthcare industry approaches patient care and resource allocation. When addressing housing and food needs generates measurable returns on investment, these interventions move from charitable activities to core business strategies.
This evolution has significant implications for healthcare delivery. Hospitals that once focused exclusively on medical treatment are now hiring social workers, partnering with community organizations, and investing in affordable housing. These activities are increasingly viewed not as peripheral to the healthcare mission but as essential components of effective patient care.
The expansion of insurance coverage for social services creates a sustainable funding model that was previously lacking. Early programs often relied on grants or hospital charity budgets, making them vulnerable to funding cuts. When Medicaid and private insurers pay for these services, hospitals can build permanent programs with dedicated staff and infrastructure.
The financial case also provides a framework for addressing health disparities. Low-income patients and communities of color experience higher rates of housing instability and food insecurity, which contribute to worse health outcomes and higher healthcare costs. Programs that address these social factors have the potential to reduce disparities while improving financial performance, aligning equity goals with business incentives.
However, challenges remain in scaling these approaches. Many community-based organizations that provide social services lack the infrastructure to bill insurance companies or meet healthcare industry requirements for documentation and data sharing. Building the necessary partnerships and systems requires significant upfront investment and coordination across sectors that have traditionally operated independently.
The programs also face questions about which interventions generate the strongest returns and for which patient populations. While the evidence shows overall cost savings, the benefits vary considerably based on program design, patient characteristics, and local context. Healthcare organizations are still learning how to target interventions most effectively and how to measure outcomes in ways that satisfy both clinical and financial stakeholders.
The regulatory environment continues to evolve as well. Federal rules governing what services Medicaid and Medicare can cover are changing, with some states receiving approval for innovative programs while others face restrictions. The extent to which government programs will embrace payment for social services remains uncertain, potentially limiting the spread of these approaches.
Privacy and data sharing present additional complications. Connecting patients with social services requires sharing health information with community organizations, raising questions about patient consent and data security. Healthcare organizations must navigate complex regulations while building systems that protect patient privacy and maintain trust.
Despite these challenges, the momentum appears strong. As more hospitals document positive returns on investment, industry interest in social determinants of health continues to grow. Healthcare conferences now regularly feature sessions on housing and food programs. Industry publications track best practices and financial outcomes. Investors and rating agencies increasingly ask healthcare organizations about their strategies for addressing social needs.
The convergence of improved health outcomes and financial benefits creates powerful incentives for healthcare organizations to expand these programs. Hospitals that successfully reduce emergency department visits and preventable admissions through social interventions gain competitive advantages in value-based payment models that reward quality and efficiency over volume of services.
For patients, the changes mean that a hospital visit might now include screening for housing instability or food insecurity, followed by referrals to community resources or direct assistance. The healthcare system is beginning to recognize that a patient's zip code and living conditions often matter as much as their medical diagnosis in determining health outcomes.
The financial returns hospitals are documenting suggest that addressing social needs is not just good for patients but also good for business. This alignment of clinical, social, and financial goals may prove to be a rare opportunity to improve health equity while strengthening the financial sustainability of healthcare institutions. Whether this approach can scale to fundamentally reshape American healthcare remains to be seen, but the early evidence provides reason for optimism that addressing the social roots of poor health can benefit both patients and the institutions that serve them.