A medical-legal partnership—first launched during the 2008 financial crisis—reduced hospitalizations among children by providing housing support and financial aid, a new study found. Amid the COVID-19 pandemic, the model could be a roadmap for tackling social determinants of health in primary care settings, as well as a pitch for reimbursement from insurers.
Researchers from the University of Cincinnati found that a collaboration between Cincinnati Children's Hospital Medical Center and the Legal Aid Society of Greater Cincinnati—in order to connect children and their families to social services—reduced pediatric hospitalizations by approximately 38% after support was received.
The referral program was housed out of six primary care clinics, three of which were based in schools. Approximately 85% of the patient population is covered through Medicaid, according to Beck. The partnership manages about 900 referrals per year, connecting patients with resources for housing insecurity, poverty-related issues and educational concerns.
Of the more than 2,200 children who received referrals in the study, 36.6% were for housing needs, 17.9% for income-related issues and 16.8% were for educational concerns. Patients and their families received legal services to combat eviction, improve environmental health concerns and connect with social services at no cost to them, Beck said. Cincinnati Children's and the Legal Aid Society both sustain the partnership through fundraising and grants, but reimbursement through insurance—specifically Medicaid—could help support the initiative long term.
"Legal advocacy like this results in lower rates of hospitalization and meaningful economic outcomes, in terms of shared savings," he said. "I think that opens conversations up about other potential ways to fund and support these types of efforts, perhaps through healthcare reimbursement."
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According to the National Center for Medical Legal Partnerships, approximately 138 general hospitals and health systems and 37 children's hospitals partner with legal organizations to help address social determinants of health among low-income patients. Elaine Fink, managing attorney at Legal Aid Society and co-author of the report, says the programs are underfunded and struggle to meet demand.
In a press release, Robert Kahn, associate chair of community health at Cincinnati Children's and co-author of the study, said, "If this were a pill that demonstrated a 38% reduction across so many kids in terms of hospitalization, every pharmaceutical company in the country would be going after it, and every healthcare payer would be figuring out how to cover it."
