The Impact of Social Determinants of Health on Your Medical Plans

Employee Benefits

The Impact of Social Determinants of Health on Your Medical Plans

Social determinants of health (SDoH) are environmental conditions that affect people’s health and well-being.1 They can include violence, unsafe water, older housing stock, air/noise pollution, access to education, healthcare services and nutritious foods. People in employer-sponsored health plans technically have – through their insurance cards – access to healthcare services. The question is, does this impact the negative effects of SDoH factors?

Unfortunately, the answer is no. SDoH factors appear to be closely associated with utilization patterns and health outcomes, especially among lower-income workers and individuals from historically marginalized groups. Additionally, analyses on behalf of our customers have shown that negative SDoH factors are associated with the following:

  • Higher rates of Metabolic conditions, including obesity, diabetes and hypertension
  • Higher rates of substance abuse treatment
  • Higher rates of hospitalization and use of Emergency Departments (ED) and lower use of preventative services (See Figure 1)
  • Fewer days supplied for diabetes maintenance medications

Larger employers can assess if SDoH factors are impacting their employees and, in turn, their health plans. Some claim data warehouse vendors have added SDoH indices based on employee addresses into their reporting. If these indices are unavailable, salary-band information can be a reasonable proxy for SDoH. Additionally, the relatively new Z-diagnosis codes2 capture SDoH in claims. Ask your carrier for reports if you do not use a claims data warehouse. Most large carriers have invested in building SDoH indices and reporting for their employer customers. Regardless of the source of information, investigate if there are specific job sites where the negative impact of SDoH is particularly evident.

Marilyn Schlein Kramer