Panel, Conference Presentation
The Business Case for Addressing Social Determinants of Health
Milken InstituteJoanne Kenen, Georges Benjamin, Thomas Moriarty, Ashley Perry, Lauren Shweder Biel, Emily Yu, Joanne Cannon, Lauren Schwader-Beal, Katherine Connelly, Michael Golinkoff
- Healthcare spending is projected to reach 20-21% of GDP within seven years, a trend expected to drive systems toward addressing social determinants to avoid billions in lost investment.
- Strategic investments in social determinants, such as housing and nutrition, are expected to yield sustainable business models that transition from philanthropic reliance to core business strategies and reimbursement streams.
- Employers face average annual productivity losses exceeding $1,600 per employee, with data indicating 80% of insured individuals are family members, retirees, or pension holders rather than current workers.
- Specific initiatives include the DC Greens produce prescription program currently funding 650 patients with plans to onboard additional Medicaid managed care organizations, and a six-year projection of $20 million in investments by philanthropy and companies across BUILD Health Challenge sites, matched by community and hospital contributions.
- CVS aims to deploy approximately 1,500 "health hub" concepts nationwide by the end of 2021, optimizing labor and inventory to address barriers like transportation, which currently prevents one-third of physician-ordered laboratory tests from being completed.
- ProMedica intends to scale impact by quantifying excess social risk internally, deploying interventions precisely, and making net new investments only when internal or community partnerships cannot meet identified needs.
- New regulatory frameworks, including Medicare Advantage rules, now permit expanded spending on social determinants compared to traditional Medicaid, creating incentives for risk-based organizations to engage with community health solutions.
- Corporate engagement is expected to rise as Fortune 500 companies and benefit managers seek solutions to cost pressures, correlating metrics like absenteeism and turnover with social determinant risks to elevate these issues within corporate strategy.
- Legal and professional integration is increasing, with lawyers joining community health groups to assist with Section 8 housing access, while health systems are encouraged to allocate one-tenth of lobbying budgets toward policies like zoning and affordable housing.
- The sector anticipates a shift from referral models to shared accountability, where health systems and community organizations follow through on assessments and hold themselves accountable to benchmarks derived from community health needs.
- Future models expect to adapt successfully for an aging society, focusing on outpatient care to decrease inpatient utilization and addressing specific physical ailments like joint issues through existing frameworks.
- Risks include the potential loss of progress if programs relying on philanthropic funding are not sustained financially, and the increasing difficulty of making a business case for interventions as they move further upstream in the social determinant chain.