Article
Healthcare has always had a complicated relationship with social determinants of health. There are camps that focus on the moral and ethical obligation to act on how social risk factors impact health outcomes. At the same time, there is a perception from the business side of healthcare that, while agreeing with the sentiment, there is simply no way to pay for solving health-related social needs in everyone’s life. This leads to a common refrain from the health equity advocates: “Everyone agrees on SDOH until someone gets out a calculator.”
However, as social determinant of health experts, we have found a simple truth: the calculator is on the side of SDOH interventions. Expert-guided social risk intervention backed by the right data saves lives and enormous amounts of money.
It comes down to very simple arithmetic: addressing social risk factors provides better outcomes that align to lower costs. This works because addressing SDOH reduces avoidable ED utilization and improves medication adherence, chronic condition management, and primary care utilization.
The results in either direction, avoidable costs and intervention impact, are quantifiable. But to make it work, you need to know who is facing what challenges and how to take effective action when that data is combined with claims or any clinical input. With that approach, the overhead shrinks, the outcomes improve, and the costs go down, and down, and down.
Every single example below is strong. The impact of all of them multiplies when deployed with Socially Determined's SDOH data because the guesswork is effectively gone. The overhead shrinks and the program costs only incur in situations where savings accumulate through improved outcomes.
This 2024 JAMA study conducted a randomized trial of $400 monthly cash benefits to 2880 high risk, high need individuals. The reduction in ED utilization and inpatient stays led to an average savings of $16,000 per person in avoidable utilization over the 9 month study. This represents a net ROI of 4.4:1. Finding the precise high-cost, high-need people is also now a sustainable, verifiable option with Socially Determined’s individual-level social risk data, especially when combined with claims.
An NHIS study of 5,603 cancer survivors found that food insecurity led to a 28% increase in all-cause mortality and, per Tufts University, a study providing high risk patients 14 medically tailored meals per week (MTM) for 3 months saved $12,046 per person in reduced hospitalizations and ED utilization. Outside of cancer, the cost of unaddressed food insecurity more than doubles the higher calculation to $77.5B per year.
A longitudinal analysis by the VA found that veterans with lung, colorectal, and breast cancer who faced housing instability, had a 10-20% higher risk of all-cause mortality than consistently housed veterans. The unhoused patients’ first year treatment cost $24,600-$67,000 more than the baseline. More broadly, people facing housing instability cost up to an additional $16,800 per stay and faced longer bed days (6.5 vs. 5.9).
PMC and AJMC reviews found that transportation support doubled colonoscopy screening completion after abnormal tests, reducing CRC cases by 26.3% and CRC deaths by 32.5%, saving $330,587 per 1000 people screened. Compared to the ride share costs ($43,000), that’s an ROI of nearly 8:1.
UAB’s Patient Connect program, a patient navigation and health literacy initiative, reduced costs by $19M per quarter. Similarly, a VA program of 92,749 members found that costs were doubled for identified cases of low-health literacy.
ePRO remote symptom monitoring in community oncology (Texas Two-Step) saw a $1,146 PMPM cost reduction and a 12.5% drop in hospitalizations through better patient monitoring and reduced transportation costs, especially in rural health communities.
A systematic meta-analysis undertaken in part by AARP found that quality of life, depression, anxiety, and self-efficacy were all exacerbated by social isolation, with each being highly impactable by low-cost interventions. With behavioral health interventions around social isolation, the cost to Medicare is $134 PMPM, ($6.7B all in) for socially isolated individuals.
The impacts are undeniable. And the good news is the industry is waking up to a tremendous opportunity to fundamentally change, and fix, the broader ecosystem of cost and care. A new piece by Flare Capital notes, “AI Enablement & Data Infrastructure: The demand for real-time, rich data sources to really understand the user is high. The social care data infrastructure remains just as important and is an overlooked opportunity in our space. This can be hamstrung by health plans and state agencies that lack real infrastructure that is ready to adopt solutions. It requires innovative strategies in data ingestion, data interoperability, and communication.”
We agree. When it comes to SDOH data and interventions, social risk is the missing layer to any healthcare performance engine, and it’s more critical than ever. The calculator is on the side of good outcomes and the right interventions on social risk. And the time to take action is now.
See for yourself with our SDOH intervention ROI calculator.