Measuring the ROI of social determinants of health interventions

Consider the following framework to effectively assess the ROI of SDoH interventions.

Throughout the past few months of the COVID-19 pandemic, it has become exceedingly clear that the social determinants of health (SDoH), such as race, housing, income, and transportation, play a considerable role in a person’s overall health and wellbeing. Across the country, payers and providers recognize this impact and are making significant strides in addressing SDoH through targeted non-clinical interventions like food delivery, utilities support. and transportation to medical appointments. However, many health care organizations still grapple with capturing and quantifying the return on investment (ROI) of SDoH interventions.

Addressing SDoH involves identifying social needs and coordinating care with an integrated network of health care and community-based organizations to improve outcomes, which can pose challenges for measuring ROI. But payers and providers can build out a foundation for SDoH ROI evaluation as they create their networks by planning how SDoH data will be identified, collected, and assessed each step of the way.

To effectively assess the ROI of SDoH interventions, consider the following framework:

1. Identify population and metrics–Align on the populations you’re aiming to help and the metrics used to evaluate the impact of interventions within those communities. Broadly, the goal of any SDoH program is to reduce the total cost of care while improving overall health outcomes. Metrics that inform total costs of care may include clinical and non-clinical measures, such as the number of emergency room visits, hospital length of stay, readmissions, average health expenditure per person per year, transportation costs, and member satisfaction.
2. Establish baselines–Create baselines for utilization and cost measures as well as the estimated costs for individual SDoH interventions. Consider the inputs you’ll collect from both clinical and non-clinical partners involved in coordinating a member’s care. For example, the baseline for cost per food delivery may be the number of individuals who receive food deliveries from an organization contracted to transport groceries from a food pantry.
3. Set targets–In most cases, population health departments will have identified outcome and cost targets before launching a SDoH initiative. However, one caveat in establishing targets is ensuring that at-risk providers with value-based contracts are considered before finalizing. Because each contract contains unique quality and cost goals, those organizations may want to see their targets baked into the broader targets associated with a SDoH initiative.
4. Monitor–Build a robust and sustainable infrastructure to capture and monitor the metrics on an ongoing basis. The people, processes, or workflows and technology which enable data collection, sharing and analysis make up this infrastructure. When vetting infrastructure solutions to implement across your SDoH networks, consider the specific needs of the network partners and determine if the tools are interoperable with existing systems, such as an EHR, to ensure information is not siloed and is readily accessible.
5. Assess and Evolve Regularly review the ROI data to assess the impact of your SDoH interventions. Did you meet your targets? Which measures are faring best/worse? Where are there gaps in care? Consider how you’re tracking against your overall SDoH program goals and evolve specific interventions as warranted to best the needs of your community.

Organizations that have implemented SDoH interventions at scale have seen considerable ROI, such as Reading Hospital, which saw a significant reduction in emergency department visits and costs. Without a system for collecting and assessing SDoH data, the impact of SDoH interventions remains unclear, and securing buy-in for additional SDoH investments can be a challenge.

Fortunately, the methods for SDoH ROI analyses are similar to the processes many population health departments are already using to assess the effectiveness of clinical interventions. By following the foundational building blocks outlined above, payers and providers will be well-equipped to conduct a thoughtful and accurate assessment of the ROI on SDoH interventions.

About the author

Manik Bhat is the founder and chief executive officer of Healthify. He was moved to create Healthify in 2013 while working as a community health worker in East Baltimore, where he saw how social needs dramatically impacted health outcomes in the community.

Manik is an advocate for addressing the social determinants of health through equitable and collaborative partnerships between health care and social service organizations.