The Business Case for Addressing Social Determinants of Health

Panelists and Core Theme:

• Moderated by Joanne Cannon (Politico), the panel featured Georges Benjamin (Public Health Association), Tom Moriarty (CVS), Ashley Perry (Socially Determined), Lauren Schwader-Beal (DC Greens), and Emily Yu (Build Health Challenge).
• The discussion shifted from the "moral case" to the "business case" for Social Determinants of Health (SDOH), emphasizing cost savings, ROI, and systemic integration rather than philanthropy alone.
• There is a consensus that SDOH definitions are evolving but universally include housing, food security, transportation, income inequality, and social support.

DC Greens Produce Prescription Program (The "Formula for Success"):

• Program Mechanics: Partners (AmeriHealth Caritas, DC Health, Giant Food, Federally Qualified Health Centers) issue produce prescriptions to Medicaid patients with diabetes, prediabetes, or hypertension in DC Ward 8.
• Operational Details: Patients receive a $20 weekly coupon for produce at Giant, paired with in-store nutritionist consultations and follow-up with clinicians every three months.
• Target Demographics: Currently serves 650 patients; funding secured from Dell and Rockefeller foundations for expansion.
• Data Integration: Utilization of a data use agreement with "Socially Determined" to access claims data, allowing for large-scale evaluation of ER diversion, medication compliance, and cost avoidance.
• Health Disparities Context: Ward 8 exhibits a 17-year life expectancy gap compared to the city average, with diet-related chronic illnesses as the top five causes of death.
• Scalability Strategy: The goal is to prove ROI to Managed Care Organizations (MCOs) to shift the program from philanthropic funding to sustainable reimbursement models.

CVS and Health System Integration:

• Strategy: Embedding SDOH interventions into core behavioral patterns (e.g., MinuteClinic visits at nights/weekends when primary care is unavailable) to increase compliance without requiring patients to change routines.
• Logistics: Addressing the barrier of 1/3 of lab tests not being taken due to 9-to-5 availability and transportation issues.
• Health Hub Concept: Plan to deploy ~1,500 health hubs by end of 2021, integrating lab testing, nutrition (de-emphasizing unhealthy items), and primary care coordination.
• Data Utility: Partnering with US News and World Report to survey 3,000 communities annually, using findings to drive local interventions.
• Referral Volume: Generated 4 million referrals back to primary care last year from MinuteClinic patients.

Build Health Challenge and Cross-Sector Collaboration:

• Funding Model: A collaborative of 15 funders (including 2 businesses like Campbell Soup) invested $20 million over six years across 37 US communities, leveraging a 2:1 community match and hospital contributions.
• Employer Impact: US employers lose over $1,600 per employee annually due to productivity loss from health issues; Dow Chemical found 80% of their insured population are non-active employees (families/retirees).
• Sustainability Focus: Moving from "throwing money" to creating reimbursement pathways where insurers save money on ER visits by funding upstream interventions (e.g., mold remediation for asthma).
• Community-Led Approach: Success relies on local coalitions (public health, hospitals, NGOs) rather than top-down directives.

Housing as a Critical SDOH:

• Dual Crises: Distinguishing between visible homelessness (often involving mental illness) and the "invisible" crisis of working-poor families unable to afford housing.
• Healthcare System Leverage: Hospitals, as major employers and community anchors, should use political clout (lobbying) on zoning and affordable housing rather than building apartments directly.
• Case Studies:
  • Unity Hospital (DC): Aggressively engaged in urban renewal 40 years ago to reduce infant mortality; program halted when leadership left.
  • Philadelphia: Public-private partnership built transitional housing for mental health patients; stability allowed for data collection showing reduced care utilization.
  • ProMedica (Toledo): Used data to identify high-risk populations, optimized existing interventions, and formed strategic partnerships before considering new investments.
• Legal Support: Integration of legal services (e.g., for Section 8 housing) identified as a high-impact, low-cost driver for housing stability.

Business Case and Funding Trajectory:

• Value-Based Care Alignment: Shifts in Medicare Advantage and Medicaid managed care rules now allow spending on SDOH, creating financial incentives for health systems to address root causes.
• Cost Drivers: Non-adherence to medication costs $300 billion annually; hospital readmissions are linked to home environment failures (e.g., lack of food or recovery supplies).
• Corporate Engagement: Fortune 500 companies (e.g., Google, Lyft, Dow) are increasingly using core competencies (logistics, cloud, benefits) to support SDOH, moving beyond traditional charity to strategic CSR.
• Workplace Metrics: Employers are linking SDOH not just to health spend, but to absenteeism, presenteeism, and turnover rates.
• Caregiver Support: Identified as a critical factor in chronic disease management, requiring better information flow and in-person reinforcement.

Challenges and Future Outlook:

• Sector Friction: Historically, public health bureaucracy and corporate speed have been mismatched ("oil and vinegar"), requiring "emulsifiers" like shared data and accountability frameworks.
• Reimbursement as the Goal: The consensus is that for SDOH to scale, funding must transition from non-profits/philanthropy to payer reimbursement (Medicaid/Medicare Advantage).
• Upstream Complexity: Addressing root causes (economic strain, education) becomes exponentially harder to quantify and fund than direct interventions (food, transport).
• Demographic Shift: As the population ages, community-based models addressing SDOH will become essential for managing chronic conditions and avoiding inpatient care.