Gaps and other data limitations can lead to shortcomings in information about health status, well-being and social concerns. Insights and improvements across the entire health care system may be bogged down or even thwarted when limited to traditional data sources for health plan, provider and employer populations.
Access is another challenge that requires a better understanding of SDOH. Many uninsured or underinsured people can’t afford health plan costs, or they live in areas that don’t offer qualified health care providers. These are people who may present to emergency departments (EDs) for care that could have been prevented or may not even be needed. Along with concerns about how to address the safety and well-being of these individuals, this ED-as-a-first-resort approach drives up the cost of care and places health care organizations and patients at major financial risk.
A closer look at SDOH analysis: Super-utilizers
It’s not unusual in some areas for people to go to an emergency department dozens of times a year. These “super-utilizers” have complex health problems and often go to EDs for health issues that could be handled by primary care physicians and social workers. While they make up just 5% of the U.S. population, super-utilizers account for 50% of health care spending.1
Super-utilizers exist in subgroups. SDOH data analysis plays a key role in learning utilization patterns among super-utilizers as compared to national benchmarks. For instance, one study related to SDOH and super-utilizers found that mental health problems are linked to more frequent ED visits:
- Mental health ED visits were more common for super-utilizers than for other patients, no matter who the health plan was.2
- Super-utilizers visited the ED on average four to five times more often than other patients.3
- The study revealed that super-utilizers accounted for an outsized percentage of ED costs.4
Addressing costly challenges, whether presented by super-utilizers or other people in your organization’s communities, starts with moving beyond a generic, population-level understanding. It extends to an individual, specific understanding of the social determinants of health.