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In part 1, we discussed the American Academy of Actuaries’ shifting approach to ROI calculation for social risk intervention. In summary, their new methodology, known as “broadening the focus,” accounts for actuarially validated, long-term projections around costs of care, management of chronic disease progression, and avoidable utilization alongside traditional, shorter-term healthcare ROI calculations.
Today, we’re providing a summary and our own thoughts on a case study the AAA shared, which demonstrates the opportunities of a more robust, data-rich approach that accounts for long- and short-term impacts.
The case study presentation was moderated by Sara Teppema, MAAA,FSA, the AAA Health Equity vice chair and Socially Determined’s chief actuarial advisor, with Dr. Laura Makaroff (American Cancer Society), Dr.Kofi Essel (Elevance Health), and Julian Xie (Share Our Strength) collectively sharing their expertise.
First, food insecurity is a clinically active variable in cancer, not a background factor. 17%–55% of households with cancer patients are food insecure. 42% of Hope Lodge guests (all-comers) screened positive for food and nutrition insecurity.[i] Food-insecure cancer patients have a 13% rate of non-inferior treatment completion. They also have a 55% rate of skipped medications due to cost vs.13% of food-secure patients.
Second, as Dr. Essel outlined during the panel discussion, food insecurity creates a cascade that affects every SDOH domain simultaneously.Financial hardship triggers reduced food budget first, then food anxiety, then lower food quality (shift to ultra-processed foods), then reduced food quantity. These choices are similarly seen in trade-offs with utilities,medications, and rent. This makes it a cross-domain SDOH problem, not just a nutrition issue.
Additionally, food is medicine (FIM) programs are complementary to, not duplicative of, federal nutrition benefits (SNAP, WIC). Medically tailored meals address clinical nutrition needs; SNAP addresses household food budget. Stacking both creates conditions of success and does not double-count. To that point: A 2017 JAMA study found SNAP is associated with$1,400/person/year in annual healthcare savings.
Regarding point 1, our member-level SDOH scores already identify food-insecure cancer patients before they show up as treatment non-adherent or in the ED through applying these social insights to claims data. This positions payers or similar organizations to include nutritional support with care plans to prevent or mitigate issues in the first place for cancer patients or their families.
To the second point regarding social risk factors amplifying barriers: our multi-domain SDOH data uniquely captures the cascade Dr. Essel described. Because food insecurity co-occurs with housing, transportation, and utility instability, identifying one SDOH need is a signal that there are others.
This is why we provide cross-domain risk profiling. Even when a single-domain project is the goal, the bigger picture helps FIM programs identify the highest-need members who will benefit most. This not only accelerates patient identification for pilots but keeps overhead low at scale.
In contrast to traditional ROI analysis, the best metrics for FIM (and many social risk programs) span multiple time scales, ensuring greater understanding from the jump:
· Short-term: medication adherence, treatment completion, ED and inpatient avoidance.
· Medium-term: pregnancy outcomes, early childhood development, primary care engagement.
· Long-term: cancer recurrence risk, chronic disease management, productivity. Forcing all of this into a one-year ROI window systematically undervalues the program.
Per the AAA’s “broadening the focus” project, the tools currently used to evaluate health programs are simply “not fit for purpose when it comes to upstream, preventive, and equity-focused interventions.” Actuaries and others should employ additional metrics and lines of questioning, as outlined in the AAA’s framework, when evaluating programs that improve long-term health.
At Socially Determined, we strive to meet the recommendations set by the AAA, not just for the sake of accuracy, but for the patients and beneficiaries of our customers. We can provide the data layer that speaks precisely to this new framework. By adding social risk data to patient-reported outcomes, engagement signals, and claims, your data becomes much more actionable.
It also makes the cost of inaction increasingly vivid but ultimately addressable.
Whether it’s about launching, defending, or just monitoring success, partnering with Socially Determined means real, hard data is now at your organization’s disposal, meeting every healthcare organization’s primary goal:reduced costs, better outcomes.
[i]Sullivan KR, Edwards P, Brinkley S. Prevalence of Food and Nutrition Insecurity Among Cancer Patients at American Cancer Society Hope Lodge®. Poster presented at the Multinational Association of Supportive Care in Cancer (MASCC) meeting, 2025.