Non-clinical risk costs payers billions.
From commercial to value-based populations, non-clinical risk shapes outcomes, costs, and member experience. With Socially Determined’s person- and community-level risk insights, plans can prioritize outreach and allocate resources where they will have the greatest clinical and financial impact.
CASE STUDY
One state health plan with 500,000 commercial lives partnered with Socially Determined. Analysis across five cohorts revealed up to $28M in potential savings.
We identified
5,000
pregnant members at risk for food and housing insecurity, each associated with poor visit adherence.
Focused interventions could deliver
$2.4M- $5.4M
in savings (2.0–3.0 ROI) while reducing NICU admissions and improving maternal outcomes.
What happens to your results when your workflows include quantifiable barriers to outcomes?
You’ve quantified everything. Except social risk.
Social risk drives over 80% of health outcomes and costs, but reactive, traditional survey techniques barely capture a fraction of that risk.
For value-based populations, real social risk data can address lower Stars and HEDIS performance, higher readmission rates, missed incentives, and shrinking value-based payments.
Turn insight into coordinated action
With a clear view of social risk, health plans can prioritize outreach, activate partners, and connect members to the services that reduce avoidable cost.
Identify and reach high-risk members facing social barriers
Connect members to community resources
Improve member engagement using social risk insights
Focus interventions where they will have the greatest impact on cost of care
Medicare Advantage
Boost Stars, close gaps, prevent costly utilization
Managed Medicaid
Improve encounter rates, reduce avoidable ED utilization, strengthen retention
Commercial Populations
Reduce PMPM and increase customer satisfaction through focused, high ROI interventions
Population Health
Focus resources on the members most likely to benefit
Community Relations/ Outreach
Invest where support drives measurable improvement
New Membership
Establish early risk visibility and unmet need when claims history is limited or unavailable
Hidden social risk drives cost for every population.
With Socially Determined, individual-level social risk is only the beginning. Those insights can be combined with claims data and stratified by cost and need. Our partners know on whom to intervene, and how to focus resources based on impact, while measuring short and long-term outcomes.
Benefit Resource Management
Design more competitive plans with better population insights and lower overhead
All Value-Based Populations
Address social-barriers affecting outcomes and costs for risk-adjustable conditions
When you know more than your competitors, you
outperform
them.
As health plans face increasing pressure to bend the cost curve, individual-level social risk insights mean better care, better member experience, stronger RFP responses, and better ROI.
Employer health plans
can offer a broader array of plans at no additional cost due to population-focused benefit packages.
Benefit management organizations
can lower overhead for themselves and partners while offering better, more specific packages.
Medicaid and ACA plans
can compete more effectively in 100% risk markets by understanding the factors that drive poor outcomes and avoidable costs.
Your secure, integrated social risk solution
We are experts in workflow and vendor integration, making adoption easy for you and your IT teams. Our SDOH insights flow seamlessly into your existing ecosystem, enhancing analytics, care management, and operational workflows without disruption.
