The Business Case for Addressing Social Determinants of Health

Panelists and Core Definitions

• The session defines social determinants of health (SDOH) as factors outside clinical settings that influence health outcomes, including housing, food security, transportation, income inequality, health literacy, and social support.
• Key panelists include Georges Benjamin (Public Health Association), Tom Moriarty (CVS), Ashley Perry (Socially Determined), Lauren Schwader-Beal (DC Greens), and Emily Yu (Build Health Challenge).
• A consensus emerged that while "food" and "housing" are universally cited as primary determinants, housing is the most expensive and complex challenge to address systemically.

Case Study: DC Greens and AmeriHealth Caritas

• DC Greens launched a "Produce Rx" program in Ward 8 (DC), a multi-generational poverty area with a 17-year life expectancy gap compared to the city average.
• The program partners with the Medicaid provider (AmeriHealth), a local grocery store (Giant), and health clinics to provide diabetic and hypertensive patients with $20 weekly coupons for produce.
• Implementation includes in-store nutritionists offering personalized tours and a three-month clinical follow-up cycle for renewed prescriptions.
• The initiative currently serves 650 patients and has secured funding from the Dell and Rockefeller foundations.
• A unique data use agreement with Socially Determined allows for the analysis of claims data to measure impact on ER diversion and medication compliance, establishing a business case for the program.
• The goal is to scale the model by proving ROI to other Medicaid Managed Care Organizations (MCOs) in the district.

Scalability and Business Case

• Socially Determined emphasizes that analytics are the "skeleton key" required to shift SDOH interventions from philanthropic pilots to core business strategies.
• Partnerships must quantify the correlation between social risk and excess utilization/cost to justify investment.
• The "secret sauce" for success involves identifying a specific community problem, forming a multisector coalition (public health, private sector, clinicians), and proving the ROI.
• Emily Yu notes that U.S. employers lose over $1,600 per employee annually due to health-related productivity losses, creating a direct financial incentive for business involvement.

Housing as a Critical Determinant

• Housing is identified as a "root cause" that impacts asthma, mental health, and educational outcomes, yet it remains the most difficult area for healthcare systems to solve alone.
• Georges Benjamin argues healthcare systems should lobby for zoning and affordable housing policies, using just one-tenth of their lobbying budget to influence public policy.
• Historical models, such as Greater Southeast Community Hospital in DC, show that hospitals can directly engage in urban renewal to improve infant mortality and community health.
• ProMedica in Toledo utilized data to target housing instability risks, allowing for "precision deployment" of existing resources and new partnerships before investing in net-new programs.
• Emerging models include public-private partnerships, such as transitional housing in Philadelphia supported by Medicaid programs and legal aid services for Section 8 applications.

CVS and Retail Health Integration

• CVS is embedding SDOH support into core care settings to align with existing patient behaviors, rather than requiring new behavioral patterns.
• MinuteClinic locations operate nights and weekends to accommodate hourly workers who cannot take time off during standard business hours.
• Approximately 33% of physician-ordered lab tests are not completed due to transportation and scheduling barriers; on-site testing aims to resolve this.
• CVS plans to deploy roughly 1,500 "health hubs" by the end of 2021 to integrate health services into neighborhood ecosystems.
• The company is actively reshaping store inventories in food deserts to increase access to healthy nutrition while de-emphasizing less healthy options.

Funding, Policy, and Market Shifts

• The transition to value-based care and the growth of Medicare Advantage and Medicaid managed care are creating financial incentives for healthcare systems to address SDOH.
• New Medicare rules allow for increased spending on social determinants, though implementation varies by state and plan.
• Lauren Schwader-Beal notes a shift from viewing food security as charity to integrating it into core business models, attracting for-profit food businesses into the space.
• Corporate participation is expanding; Fortune 500 companies like Google (launching a food as medicine accelerator) and Lyft are joining to address SDOH using their core competencies.
• Employers are increasingly engaging with SDOH due to metrics beyond healthcare spend, including absenteeism, presenteeism, turnover rates, and promotion rates.

Challenges and Future Outlook

• A primary challenge remains the coordination between healthcare systems and community organizations, moving beyond simple referrals to shared accountability and risk.
• The conversation is evolving from "screening and referral" to integrated, accountable networks where funders and providers share the risk and cost of intervention.
• Panelists warn that while short-term wins exist, solving deep-rooted issues like redlining and food deserts is a long-term game requiring sustained investment.
• Caregiver support is identified as a critical, often overlooked social determinant that significantly impacts health outcomes for those with chronic conditions.
• The ultimate goal is to decrease inpatient utilization and shift care to community-based settings, a necessity for an aging population and an unsustainable healthcare cost curve projected to reach 20-21% of GDP.