Bridging the Benefits Enrollment Gap Through Emergency Department Interventions
Health-related social needs (HRSNs) — social and economic needs that affect an individual’s ability to maintain their health and well-being — are key drivers of health outcomes. There’s an increased urgency to screen for unmet social needs in health care settings. As part of the health care safety net, emergency departments (EDs) offer a potential venue to identify individuals with HRSNs who may have relatively less engagement with health care or social services.
Beyond just screening for unmet needs, it’s critical to ensure that there’s accompanying interventions to address both immediate and long-term HRSNs. Traditionally, interventions involve referrals to external community organizations. However, new partnerships between health care and social services agencies seek to expand current intervention strategies. For example, medical-financial partnerships (MFPs) are collaborations to co-locate health care and financial services organizations, seeking to expand access to financial resources.
Utilizing Public Benefits to Improve Health Outcomes
Enrollment in public benefits is associated with better health outcomes and reduced health care costs and utilization — studies find that Medicaid exposure during early childhood leads to better overall health in adulthood. However, an estimated $450 million in state and federal benefits that address food insecurity, financial instability, access to care, and other social needs went unclaimed in Philadelphia in 2020, with over $60 billion unclaimed around the United States.
There are many reasons for this gap, including lack of awareness about programs, barriers in filing applications, and psychological costs of stigma associated with seeking public assistance. Benefits Data Trust (BDT), a nonprofit organization that helps people apply to public benefit programs and collaborates with partners to create a more accessible system, works to mitigate that gap for individuals in Philadelphia and beyond.
Studying How Emergency Departments Can Intercept Eligible Individuals
In partnership with Penn Medicine and BDT, the Accelerate Health Equity (AHE) research team recently concluded a study to determine if emergency rooms are an effective place to intercept patients who may be eligible for financial assistance. The objective of this study was to survey Emergency Department (ED) patients to determine the proportion that were eligible for unclaimed public benefits. In addition, the team surveyed patients to assess whether screening for benefits eligibility in the ED was appropriate and explore strategies for optimal linkage to application services.
“Working with the Accelerate Health Equity team has enabled BDT to interact with people at a key life event when they may be more motivated to apply for benefit programs. Visits to the emergency department can impose financial stresses on top of the health issues that led patients to seek care.”
- Conor Carroll, Pennsylvania Engagement Manager, Benefits Data Trust
Emergency departments serve patients from diverse socioeconomic backgrounds with a range of unmet social needs and already screen patients for HRSNs including access to transportation, exposure to violence, and housing and food insecurity. However, whether ED patients are eligible for additional unclaimed public benefits is uncertain. It is also unclear whether ED patients are amenable to discussing public benefits, and best practices for initiating these conversations.
Building a Survey to Understand the Needs of Emergency Department Patients
AHE conducted a cross-sectional, in-person survey in a convenience sample of ED patients at Presbyterian Medical Center and the Hospital of the University of Pennsylvania from May to September 2022. The survey included questions around awareness of and current enrollment in public benefits, prior experience applying for public benefits, and interest in receiving hospital-based support for benefits applications. Patients responded well to the survey and seemed interested in participating.
“More so than anything, patients seemed appreciative of the opportunity to have their voices heard and potentially bring about positive changes for themselves and their communities.”
- Aliza Haider, Clinical Research Coordinator, Penn Medicine
In addition to the survey, the study helped to determine whether patients were potentially eligible for benefits via an existing web-based screening application, Benefits Launch Express (BLX), developed by BDT. BLX queried self-reported sociodemographic data, including income, expenses, household size, dependents, disability status, and active benefits enrollment. All study participants received a summary of their eligible benefits and a flyer with phone numbers for benefits navigators.
Understanding the Findings
The AHE team approached 282 eligible patients in the ED — of those, 202 (72%) completed the survey. In this study, we found that ED patients with public or no health insurance were often eligible for unclaimed state or federal benefits. Furthermore, participants demonstrated high levels of interest in applying for benefits and receiving help from a hospital-based team. However, patients reported interest in receiving application support after leaving the hospital, suggesting that while the ED may be an appropriate setting for screening, it may not be optimal for completing applications. Luckily, BDT provides application assistance and could be a helpful option for patients post discharge.
“I have seen too many flyers with phone numbers handed to patients who ask about resources, like housing or medication assistance, with little ongoing support to help them navigate and ensure that they make that connection. I see studies like ours showing that we can better integrate medical and social services to meet patients where they are and find the resources that do exist.”
- Dr. Austin Kilaru, Assistant Professor of Emergency Medicine, Perelman School of Medicine and Principal Investigator, AHE LEAP Study
There is often ample waiting time for stable patients receiving emergency care that could provide an opportunity to connect with hospital-based benefits support teams, particularly if screening is fast, efficient, and well tolerated by patients. Overall, patients’ openness to receiving benefits assistance from a hospital-based team demonstrates promise for future collaborations between EDs and financial services organizations.
The study findings also highlight the importance of warm handoffs to sustain the application process after leaving the hospital. While screening is helpful, the AHE team learned that screening must be accompanied by sustainable, effective interventions that can help ED patients apply for benefits for which they are eligible — in Philadelphia, BDT and their team of benefits navigators can help to fill that need.
In conclusion, this study suggests that EDs may be an acceptable clinical setting to identify patients who are eligible for unclaimed public benefits. The research team has continued this work with a randomized clinical trial testing a text message intervention to connect patients recently discharged from the ED to benefits navigators at BDT. Results will be forthcoming later this year — stay tuned for more updates on this project.
