5 Shocking Ways Social Determinants of Health (SDOH) Can Boost Health: Why Smart Health Plans Invest in Social Determinants

Author’s Note: Part of a Health As a National Strategic Imperative (HAANSI) and Strategic Health Leadership (SHELDR) Series With Emphasis on West Virginia

Blip-Zip Executive Summary

Health insurance companies can’t afford to ignore social determinants of health (SDOH) like housing, food access, and transportation. These factors significantly impact member health, driving up costs and harming well-being. By investing in SDOH solutions, insurers can achieve cost savings, improve member outcomes, and enhance their reputation. This article explores the benefits and practical steps for integrating SDOH into healthcare strategies.

Blip-Zip Takeaways

• SDOH are powerful health influencers, impacting costs and outcomes more than medical care.
• Addressing SDOH leads to healthier members, lower costs, and a stronger brand.
• Collaborations and data-driven interventions unlock the potential of SDOH solutions.

Key Words

Social determinants of health (SDOH),  Health insurance, Healthcare costs, Member health outcomes, Community partnerships

Introduction to Interest in the Social Determinants of Health

Health insurance companies such as UniCare, Aetna, and The Health Plan under the West Virginia Health Medicaid health plan have or should have a vested interest in the social determinants of health (SDOH). The SDOH plays a dynamic role in determining the health outcomes of beneficiaries and communities.

The SDOH are the social, health, living, and economic conditions that influence and even drive the health of individuals, families, and communities. The SDOH, sometimes called social drivers of health, includes visible and invisible factors, such as poverty, access to healthcare, education, housing, and workforce development.

Importance and Definition of the Social Determinants of Health (SDOH)

Social determinants of health (SDOH) are non-medical factors influencing health outcomes. They are the conditions in which people are born, grow, work, live, and age and the broader drivers and systems shaping the conditions of daily life. As described in the Figure, these forces include economic policies and systems, development agendas, social norms, social policies, racism, climate change, and political systems. Centers for Disease Control and Prevention (CDC) has adopted this SDOH definition from the World Health Organization.

Many drivers of health care costs fall outside clinical care.

Social and economic determinants, health behaviors, and physical environment drive utilization and costs. State-level health officials have been challenged to address the SDOH. For example, CMS to Health Officials memo: Opportunities in Medicaid and CHIP to Address Social Determinants of Health (SDOH), and CMS Framework for Health Equity 2022–2032. Addressing health-related social needs with enhanced clinical-community linkages can improve health outcomes. CMS has expanded Medicare Advantage for coverage of the SDOH. By expanding coverage for benefits that address SDOH, there are savings opportunities for payers and broadening opportunities for new entrants to healthcare.

In a study on the social determinants of health, Healthcare’s Blindside, The Overlooked Connect Between Social Needs and Good Health, providers want to prescribe social services. Four in five physicians say patients’ social needs are as essential to address as their medical conditions, according to a new survey conducted by Harris Interactive on behalf of the Robert Wood Johnson Foundation. For physicians serving patients in low-income communities, nine in ten physicians believe this is true.

In this national survey of primary care providers and pediatricians, 85 percent believe that unmet social needs like access to nutritious food, reliable transportation, and suitable housing lead directly to worse health for all Americans. Furthermore, 4 in 5 physicians feel they need more confidence in meeting their patients’ social needs, and they believe this impedes their ability to provide quality care.

Beneficial Interests of Social Determinants of Health

Health insurance plan companies are interested in the SDOH because they directly impact their members’ health and well-being and ultimately affect healthcare costs. They also impact their bottom lines. For example, the SDOH directly impacts health outcomes. Research shows that SDOH is more influential than clinical care in determining an individual’s health status. For example, a person’s socioeconomic status is a significant determinant of their health, with low-income individuals having higher rates of chronic conditions such as diabetes, heart disease, and asthma.

Environmental factors, especially those under a community leader’s control, such as access to clean water, air quality, and exposure to toxins, can significantly impact health outcomes. By understanding and addressing SDOH, health insurance plan companies can improve the health outcomes of their members and reduce healthcare costs. Here are more examples of the need to invest in the SDOH:

1. Housing  (Example: West Virginia’s 2020-2024 Housing Plan): Studies show strong evidence of the benefits of “housing first” interventions that provide supportive housing to individuals with chronic health conditions (including behavioral health conditions). Benefits include improved health outcomes and, in some cases, reduced healthcare costs. In addition, interventions that reduce health and safety risks in homes, such as lead paint or secondhand smoke, can also improve health outcomes and reduce costs.
2. Food and Nutrition (example: West Virginia’s State-Wide Plan to Improve Physical Activity and Nutrition): Efforts to improve food access through healthy food environments, public benefit programs, health care systems, health insurers, and evidence-based nutrition standards can lower health care costs and improve health outcomes.
3. Transportation (Example: West Virginia’s 2050 Multimodal Long-Range Transportation Plan (LRTP):  Enhanced built environment interventions, including sidewalks, bicycle infrastructure, and public transit infrastructure, make physical activity easier, safer, and more accessible. Non-emergency medical transportation is cost-effective by increasing preventive and outpatient care and decreasing the use of expensive care.
4. Social and Economic Mobility (Example: West Virginia Community Development Hub): Multiple randomized trials show that cash payments to families and income support for low-income individuals with disabilities are associated with better health outcomes. Early childhood care and education are also associated with positive health outcomes.
5. Health Care and Social Service Coordination: Some studies of care management and coordination using multi-disciplinary teams that support screening for non-medical health-related social needs (HRSN) show reduced total cost of care and improved health outcomes, but the evidence on the value is mixed. Investments in referral and coordination of care processes and technology platforms such as West Virginia-UNITE US improve access to services when needed and where needed. The establishment of more robust regional and county collaboratives, such as the Family Resource Network of the Panhandle, enhance knowing about local services and capabilities, using directories to find services such as FINDHELP.COM and 211 West Virginia, and building relations for better referrals and coordination of care.

Addressing the SDOH and drivers helps health insurance plan companies to reduce healthcare costs. Research has shown that addressing SDOH can lead to a reduction in healthcare utilization and costs. For example, a Kaiser Family Foundation study found that Medicaid beneficiaries who received housing assistance had lower rates of emergency room visits and hospital admissions, resulting in cost savings for the program.

By addressing SDOH, health insurance plan companies can improve the health of their members and reduce healthcare costs, resulting in a mutually beneficial situation for both the company and its beneficiaries.

Following Through

Addressing SDOH can also improve the overall quality of care for its members. Following through is the key to success. Identifying gaps and needs with analytics from data sources such as the Robert Woods Johnson Foundation County Health Rankings would be a good start. Identifying opportunities to invest or improve by following through on the results of community health needs assessments (CHNA), such as those at WVU Medicine, Meritus Health, and Valley Health reflects a commitment to invest and improve services and coordination.

Supporting state-wide health plans and initiatives, such as those in the West Virginia Prevention Strategic Plan, 2021-2023, reduces the net costs per capita for healthcare, social services, and mental health services. By understanding the top gaps and needs, health insurance plan companies can better understand the unique needs of their members, work with community stakeholders and develop interventions to improve health outcomes.

These actions include providing or enhancing access to community resources such as transportation, healthy food options, and social support services. By providing these services, health insurance plan companies can improve their members’ health outcomes and overall quality of life.

Summary

Health insurance plan companies such as UniCare, Aetna, and The Health Plan under the West Virginia Health Medicaid health plan and healthcare organizations should be interested in the SDOH. The drivers directly impact health outcomes, bottom lines, and reputation. By addressing SDOH, organizations, through collaboratives, can improve the health and well-being of their members, reduce healthcare costs, and improve the overall quality of care. It is crucial for health insurance plan companies to continue to prioritize SDOH in communities in their policies and practices to ensure that their members receive the highest quality of care possible.

Deep Dive Discussion Questions for Your Next Meeting, Seminar or Class

Purpose: Encourage reflection and application of SDOH concepts.

• How can we identify the specific SDOH impacting our community/organization?
• What partnerships or collaborations could address key SDOH challenges?
• What ethical considerations arise when addressing SDOH in our work?
• How can we measure the impact of SDOH interventions on health outcomes/costs?
• What personal biases or assumptions might influence our approach to SDOH?

Professional Development and Learning Activities

Purpose: Provide practical ways to engage with SDOH concepts.

• Community Mapping Activity: Map local resources addressing SDOH needs.
• SDOH Case Study Analysis: Analyze a successful SDOH intervention.
• Role-Playing Scenarios: Practice addressing SDOH concerns with patients/clients.
• Data Visualization Workshop: Translate SDOH data into meaningful insights.
• Policy Advocacy Simulation: Advocate for policies that address SDOH.

Resources, References, and Citations

• Centers for Disease Control and Prevention (CDC): https://www.cdc.gov/about/sdoh/index.html (2023)
• World Health Organization (WHO): https://www.who.int/health-topics/social-determinants-of-health: https://www.who.int/health-topics/social-determinants-of-health (2023)
• Robert Wood Johnson Foundation: https://www.rwjf.org/ (Reports and initiatives on SDOH)
• American Public Health Association (APHA): https://www.apha.org/ (Policy statements and resources on SDOH)
• Robert Wood Johnson Foundation County Health Rankings & Roadmaps: https://www.countyhealthrankings.org/ (2023)

About the Author

I am passionate about making health a national strategic imperative, transforming and integrating health and human services sectors to be more responsive, and leveraging the social drivers and determinants of health (SDOH) to create healthier, wealthier, and more resilient individuals, families, and communities. I specialize in coaching managers and leaders on initial development, continuously improving, or sustaining their Strategic Health Leadership (SHELDR) competencies to thrive in an era to solve wicked health problems and artificial intelligence (AI).

Visit https://SHELDR.COM or contact me for more BLIP-ZIP SHELDR advice, coaching, and consulting. Check out my publications: Health Systems Thinking:  A Primer and Systems Thinking for Health Organizations, Leadership, and Policy: Think Globally, Act Locally. You can follow his thoughts on LinkedIn and X Twitter: @Doug_Anderson57 and Flipboard E-Mag: Strategic Health Leadership (SHELDR)

Disclosure and Disclaimer:  Douglas E. Anderson has no relevant financial relationships with commercial interests to disclose.  The author’s opinions are his own and do not represent an official position of any organization including those he consulted.  Any publications, commercial products, or services mentioned in his publications are for recommendations only and do not indicate an endorsement. All non-disclosure agreements (NDA) apply.

References: All references or citations will be provided upon request.  Not responsible for broken or outdated links, however, report broken links to [email protected]

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