Actionable Insights Newsletter

Translating research to power whole health

Issue 8    |    March 2024

Health-related social needs and whole person health

Unmet health-related social needs (HRSNs) can be a barrier to achieving whole person health. Elevance Health developed a pilot survey to assess the prevalence of these needs among its affiliated health plan members in two states, and then linked respondents’ survey data with their claims data to evaluate how such needs relate to health, utilization, and spending.

Enterprise Analytics Core domain(s): Whole person health, community health (SDoH)

Summary

Background
HRSNs refer to unmet social needs, such as access to healthy food, quality housing, or reliable transportation, and are associated with poorer health outcomes. A health systems’ limited information on individuals’ HRSNs can hinder the ability to fully achieve a whole health approach. Although commercially insured adults comprise approximately two-thirds of the U.S. adult population, they are the least likely to be surveyed about their social needs. Thus, little is known about the prevalence of HRSNs in this population. This analysis reports only on findings pertaining to commercially insured Elevance Health members.

This pilot survey assessed the prevalence of HRSNs among commercially insured Elevance Health members in two states, and then linked their survey and claims data to evaluate how such needs relate to health, utilization, and spending.

Methods
In this cross-sectional study, we utilized survey data from commercially insured adult members residing in Georgia and Indiana. These two states were selected to provide geographic and demographic diversity. A stratified quota probability sampling strategy was implemented to ensure each state’s commercially insured survey respondents were representative of their respective state’s commercial health plan membership by gender, age, social vulnerability index (SVI) ranking, and urbanicity of residence.

The survey was based on extant health and social need screening tools and questions, including the PRAPARE Screening Tool, the CDC Healthy Days Measure, and questions from the HRSN Screening Tool. Respondents were considered to have a specific HRSN if they indicated need through their response to at least one of the relevant survey questions. Self-reported health was assessed through the CDC Healthy Days Measure in which respondents reported the number of physically and mentally unhealthy days during the 30 days prior to the survey.

HSRNs were measured across nine different domains (Figure 1): healthcare access, financial wellbeing, internet access, housing quality, healthy food access, interpersonal safety, housing stability, reliable transportation, and social support. Survey data were linked to medical claims data in Carelon Research’s Healthcare Integrated Research Database (HIRD^®), and regression models were used to estimate the relationship between HRSNs and self-reported health, emergency department visits, three major health outcomes (anxiety/depression, hypertension, and type 2 diabetes), and healthcare costs (medical and pharmaceutical).

Results

• A total of 1,160 surveys were completed with commercially insured members (790 in Georgia; 370 in Indiana).
• Out of nine possible HRSNs, 76% of respondents reported at least one HRSN, and more than one in four reported at least three HRSNs (i.e., “high” HRSN). The most frequently reported HRSNs were healthcare access (53%), social support (38%), and financial wellbeing (31%) (Figure 1A).
• Respondents with high (>3) HRSN reported twice as many physically and mentally unhealthy days in the last month than those who reported “low” (≤2) HRSN (11.5 vs. 5.1 unhealthy days) (Figure 2A).
• Each HRSN was associated with 2.2 additional unhealthy days per month, 3.0% higher prevalence of anxiety/depression, and 2.2% higher prevalence of hypertension (Figure 2B).
• Each HSRN was also associated with higher healthcare resource use and cost, most prominently 3.9 more emergency room visits per 1,000 member-months, and $1,418 higher total healthcare spending over a 12-month period.

Panel A. Prevalence of health-related social need

Panel B. Prevalence of the count of health-related social needs

Source: Author calculations from Elevance Health's Social Risk Survey.


Figure 2. Self-reported health and healthcare outcomes by number of health-related social needs 

Panel A. Self-reported health outcomes

Panel B. Healthcare outcomes

Source: Author calculations from Elevance Health's Social Risk Survey linked with administrative claims data.

Key takeaways