In health care, more money is being spent on patients' social needs ...

"This is a chance for me to take care of myself better."When doctors at a primary care clinic in Philadelphia noticed many of its poorest patients were failing to show up for appointments, they hoped giving out free rides would help.But the one-time complimentary ride didn't reduce these patients' 36% no-show rate at the University of Pennsylvania Health System clinics."I was super surprised it did not have any effect," says Dr. Krisda Chaiyachati, the Penn researcher who led the 2018 study of 786 Medicaid patients.Many of the patients did not take advantage of the ride because they were either saving it for a more important medical appointment, or preferred their regular travel method, such as catching a ride from a friend, a subsequent study found.It was not the first time that efforts by a health care provider to address patients' social needs — such as food, housing and transportation— failed to work.In the past decade, dozens of studies funded by state and federal governments, private hospitals, insurers and philanthropic organizations have looked into whether addressing patients' social needs improves health and lowers medical costs.But so far it's unclear which of these strategies, focused on so-called social determinants of health, are most effective or feasible, according to several recent academic reports that evaluated existing research on the interventions. To get around this, states have in recent years sought waivers from the federal government and pushed private Medicaid health plans to address enrollees' social needs.The move to address social needs is gaining steam nationally because, after nearly a dozen years focused on expanding insurance under the Affordable Care Act, many experts and policymakers agree that simply increasing access to health care is not nearly enough to improve patients' health.That's because people don't just need access to doctors, hospitals and drugs to be healthy, they also need healthy homes, healthy food, adequate transportation and education, a steady income, safe neighborhoods and a home life free from domestic violence — things hospitals and doctors can't provide, but that in the long run are as meaningful as an antibiotic or an annual physical.Researchers have known for decades that social problems such as unstable housing and lack of access to healthy foods can significantly affect a patient's health, but efforts by the health industry to take on these challenges didn't really take off until 2010 with the passage of the ACA. The law spurred changes in how insurers pay health providers — moving them away from receiving a set fee for each medical service, to payments based on value and patient outcomes.As a result, hospitals now have a financial incentive to help patients with nonclinical problems — such as housing and food insecurity — that can affect health.Temple University Health System in Philadelphia launched a two-year program last year to help 25 homeless Medicaid patients who frequently use its emergency room and other ERs in the city. And the program has helped keep her out of the hospital."This is a chance for me to take care of myself better," she says.Her apartment assistance is set to end next year, when the Temple program ends, but administrators say they hope to find all the participants permanent housing and jobs."Hopefully that will work out and I can just live my life like normal people do and take care of my priorities and take care of my bills and things that a normal person would do," Stewart says."Housing is the second-most impactful social determinant of health after food security," says Steven Carson, a senior vice president at Temple University Health System. And "frequent flyer" patients can rack up health care bills many times that amount through ER visits and follow-up care.If Temple wants to help dozens more patients with housing, it will need tens of millions of dollars more per year.Still, Temple officials say they expect the effort will save money over the long run by reducing expensive hospital visits — but they don't yet have the data to prove that.The Temple program was partly inspired by a similar housing effort started at two Duke University clinics in Durham, North Carolina.