Investing in SDoH Returns Tangible Results

For more than a decade, research has shown that investing in Social Determinants of Health (SDoH) positively impacts health outcomes, health care costs, and quality of care. Estimates are that 60-90 percent of health outcomes are driven by SDoH factors that include housing, employment, transportation, food stability, health care, crime, poverty, etc. In our August article, Prioritizing Social Determinants During a Pandemic, we reviewed these social drivers and the evidence of their impact on population health. However, the literature suggests that many payers, providers, and health systems do not prioritize SDoH as a critical factor in budgeting and planning. Why the disconnect?

Industry experts have shared that other essential projects and budget initiatives often compete for the same investment dollars. Additionally, it can be challenging to quantify the Return on Investment (ROI) for social interventions, leaving physicians and health executives unsure of how to make a solid case for funding SDoH initiatives.

Still, as the industry transitions to a value-based model, many believe the need for an innovative new framework exists – one in which funds are regularly and strategically committed to addressing some of the most predictable precursors to poor health and high health care costs. Several programs across the nation have already seen impressive results from investments in social determinants; a few are cited below.

• In a hallmark study from the University of Pennsylvania, a group of community health workers providing targeted social assistance to 302 low-income, high-risk patients contributed to $1.4 million in Medicaid savings for the year.
• Mom’s Meals in Iowa addresses food insecurity and condition-related nutrition, including home delivery of meals, for older adults in Medicare Advantage Plans. The results have included a 50-70 percent decrease in admissions associated with proper nutrition after a hospitalization, and 30-40 percent lower monthly average healthcare costs.
• Montefiore Health System in the Bronx created a program that focused on housing homeless patients, which reduced emergency room visits and unnecessary hospitalizations and resulted in an annual ROI of 300 percent.
• In Chicago, the Sinai Urban Health Institute (SUHI) reduced asthma-related ED visits by 73 percent and hospitalizations by 75 percent during the program’s first year by sending community health workers into patient homes for one-on-one education and assistance.

Locally, the Delaware Community Foundation, the University of Delaware Partnership for Healthy Communities, and Delaware Department of Health and Social Services launched Healthy Communities Delaware (HCD) to accelerate progress on “community-driven priorities around the social determinants of health.”

The State of Delaware is one investor in the communities HCD is collaborating with, and the initiative aims to bring public and private investors to the table. Complex problems require multi-faceted solutions as well as significant, long-term investment across sectors. Poor health outcomes have not been created by one problem, nor will they be improved by one solution. Investments through Healthy Communities Delaware include housing and food-security work on the Eastside of Wilmington, and resource navigation and civic engagement for Latinos in New Castle and Sussex Counties. None of the challenges in these areas can be solved by single sectors, agencies or by investments over a 1-3-year funding timeframe.

We can make a larger impact by working together-- aligning funding sources for evidence-based work in targeted geographic areas. We can begin with evidence-based interventions that improve both health outcomes as well as provide financial savings, such as those outlined in recommendations from the Centers from Disease Control and Prevention’s Health Impact in Five Years (HI-5):

• Early childhood education
• Clean diesel bus fleets
• Public transportation system
• Earned income tax credits
• Home improvement loans and grants
• Water fluoridation

Collaborative investments can mitigate risk, increase impact, and increase the likelihood of social and financial returns on investment.

Critical Elements to Drive Sustainability of Investment in Social Determinants of Health

Industry experts underscore the need to drive sustainable funding to support SDoH initiatives. One commonly shared strategy toward this end is to articulate ROI --- clearly define it and demonstrate how to calculate it: This is not always an easy task. However, by examining what has worked for others in the industry, some common approaches emerge:

• Give CFOs and CEOs a clearly defined reason to invest in SDoH – In a paper published by McKinsey Group, the author suggests expressing the objectives of SDoH initiatives in terms of health gains and cost reductions.
• Define ROI metrics with a direct cause and effect – This makes it easy for investment executives to understand how a funding commitment can turn into improved healthcare and cost-savings.
• Design focused initiatives vs. comprehensive ones – Overly broad interventions that try to solve every problem at once are challenging to track and measure.
• Target the social drivers that significantly impact healthcare savings and improve population health outcomes; underscore those SDoH initiatives that maximize improvements in health outcomes and offer a return on investments.
• Link ROI with multiple variables – many social drivers can influence Health conditions. In assessing the ROI of SDoH, include all of the cause and effect variables for a more accurate picture.
• Develop community-based initiatives – With input from a variety of community stakeholders, SDoH programs can adapt to the specific needs of the individuals they serve.

To further aid in defining strategies to ensure the sustainability of SDoH programs, community-based organizations and their health system partners can take advantage of an ROI calculator from the Commonwealth Fund. The calculator helps stakeholders “plan sustainable financial arrangements to fund the delivery of social services to high-need, high-cost (HNHC) patients...” Such patients often consume healthcare resources due to their complex social, medical, physical, and behavioral health needs. Research shows that a holistic model combining medical care with social supports can be highly beneficial for this population.

From private payers to public health agencies, there has been a heightened focus on SDoH programs as efforts to drive value-based care advances. Strategic investments in SDoH have shown the real value and promise of the short and long-term positive impact of SDoH initiatives; such investments deliver on achieving improved population health and cost savings.  

Note: This article represents a compilation of information published by others and does not constitute medical, legal, financial, or consulting advice. All information is believed to be current and accurate at the time of posting. References and links to third parties do not constitute an endorsement, sponsorship, or warranty, expressed or implied.

Resources

The ROI of Addressing Social Determinants of Health, Ohanian, A. AJM Jan 2018. Retrieved from https://www.ajmc.com/view/the-roi-of-addressing-social-determinants-of-health

Investing in Social Determinants of Health Yields High ROI, Famankinwa, J. Home Health Care News. Feb 2020. https://homehealthcarenews.com/2020/02/investing-in-social-determinants-of-health-yields-high-roi/

Addressing the social determinants of health: Capturing improved health outcomes and ROI for state Medicaid programs. Coe, E., Berg, M., Parmar, S., and Feffer, D. McKinsey Company. April 2019. Retrieved from https://healthcare.mckinsey.com/addressing-social-determinants-health-capturing-improved-health-outcomes-and-roi-state-medicaid/

Welcome to the Return on Investment (ROI) Calculator for Partnerships to Address the Social Determinants of Health. The Commonwealth Fund. Retrieved from: https://www.commonwealthfund.org/roi-calculator

Investments in social determinants will pay off, with better outcomes and value. Miliard, M. Healthcare IT News. Sept 2019. Retrieved from: https://www.healthcareitnews.com/news/investments-social-determinants-will-pay-better-outcomes-and-value

Postcard from Phoenix: Addressing SDoH in Medicare Advantage Plans. HealthEdge, Feb 2020. Retrieved from: https://www.healthedge.com/blog/addressing-social-determinants-health-medicare-advantage-plans

4 Top Successful Social Determinants of Health Programs. Kaplan, D. Managed Healthcare Executive, Jan 2020. Retrieved from: https://www.managedhealthcareexecutive.com/view/fda-updates-assays-used-in-cancer-care-get-green-light

Healthy Communities Delaware: https://healthycommunitiesde.org/

Delaware Community Foundation: https://www.delcf.org/community/hcd/