The healthcare industry has made meaningful progress in acknowledging how Social Determinants of Health (SDOH) shape patient outcomes. Research from the National Library of Medicine shows that over half of health outcomes are driven by non-clinical factors such as housing, transportation, education, access to healthy food, and other everyday conditions. These influences are especially pronounced in Medicaid populations, where social and economic disparities often contribute to poorer outcomes and higher costs.

Many health plans are integrating SDOH into their care strategies as value-based care models continue to expand (learn more about AssureCare’s efforts in value-based care here). However, effectively capturing and applying SDOH data remains a significant challenge. Without the infrastructure to connect SDOH insights with clinical data, organizations struggle to identify and address the root causes impacting their members’ health.

For Medicaid programs, closing this gap is becoming increasingly urgent. The Centers for Medicare & Medicaid Services (CMS) has elevated health equity as a top priority, requiring plans to demonstrate how they are addressing SDOH within their communities. Meeting these expectations isn’t just about compliance - it presents a clear opportunity to improve outcomes and reduce costs. Practical interventions, such as providing transportation to medical appointments, have shown a reduction in missed visits and unnecessary emergency department utilization, ultimately supporting better chronic disease management and lower costs.

Technology is critical in making SDOH insights truly actionable. Platforms like MedCompass, which integrate SDOH data with clinical and claims information, give care teams a more complete picture of each patient. This enables targeted, effective interventions, like the ability to identify individuals at risk for food insecurity and connect them with local resources that support both nutrition and overall well-being.

As Medicaid programs continue to evolve, SDOH will remain central to effective population health management. Organizations that invest in capturing, analyzing, and acting on SDOH data will not only meet regulatory expectations but also drive measurable improvements in care delivery and member outcomes.