How employers can address social factors in employee health care programs to lower costs

In the ongoing effort to lower health care costs and improve outcomes for members and their families, there is an increasing focus on addressing the social determinants of health. 

These factors vary greatly from community to community, but collectively can have a significant impact on Americans’ overall health. In fact, behaviors such as diet, tobacco use and exercise drive only about 30% of a person’s overall health. The rest — 70% — is driven by a combination of a person’s physical environment, access to clinical care and socioeconomic factors.1

Employers know that the health and well-being of their employees is essential to delivering on their corporate objectives and commitments. That’s why it’s important for employers to have practical ways to help address health care costs driven by a host of factors, including social determinants.

Community influencers and social determinants of health

Community influencers are geographically specific factors that contribute to health challenges for local populations – which in turn can affect an employer’s health care costs. By better understanding these influencers at the local level, employers can identify the health interventions that will deliver the greatest return on investment to improve their employees’ health and lower costs. 

“What we’re talking about is much deeper than a demographic analysis of employees,” said Craig Kurtzweil, senior vice president of Analytical Innovation with UnitedHealthcare. “Employee demographics are an important component, but what can help drive change is to marry that information with data about the specific barriers to better health people face in the community. We’ve designed a tool that helps us do that.”

In development for 3 years, Optum® CommunityHealth is a framework of more than 100 “vital sign” measures that describe the performance of health care in more than 300 communities across the United States. It’s based on information from more than 100 million patients, and offers insights into the community influencers that employers may face in trying to achieve the best health outcomes among their workforce.2

The project identified 4 primary domains affecting health care cost in the nation’s communities: 

  • Community Spending, which identifies and ranks a community’s overall health spend;
  • Social Determinants, factors such as community engagement, health literacy, individual engagement, addictive behavior, healthy communities, insurance levels and obesity prevalence;
  • Health System Attributes, which include health information technology adoption, integration, payment incentives and access to care; and
  • Community Health Outcomes, which include factors such as life expectancy, well-being, avoidable utilization, care-match patient goals, evidence-based care and preventive services. 

How where your employees live influences outcomes

Each of the domains can influence health care costs for employers, including claim risk scores, emergency room visits and other consequences that drive up the cost of health care. By analyzing the data, we can identify the best  and worst-performing measures for a specific community. 

For example, the Optum® CommunityHealth data show that Chicago has high emergency room use, at 183 visits per 1,000 patients. The data identifies a number of factors contributing to this, including lower scores for individual engagement in health care, health literacy, addictive behavior and healthy communities, with individual engagement being the lowest. Furthermore, the data shows that medication adherence is a key challenge for the community, and diabetes medication adherence specifically scores significantly below the national mean, meaning it has the most room for improvement.3

“Using Optum® Community Health, we can choose any market and dive into a variety of metrics regarding social determinants of health,” Kurtzweil said. “We can pull data that shows UnitedHealthcare experience for cost, utilization, compliance, and disease prevalence and now align that data against the community influencers such as poverty rates, education levels, housing and health literacy. This provides employers with a much more powerful tool to design health care strategies that are more responsive to the challenges their employees may face.”

More systemic change also necessary to tackle social factors

UnitedHealthcare is helping to address the challenge of social determinants on multiple fronts. It has invested more than $400 million in affordable housing programs since 2011,and in 2017 acquired a non-emergency medical transportation service, National MedTrans, which is helping ensure millions of members in 15 states can get to their appointments.5

The company has already assisted over 600,000 of its members with over 785,000 referrals to social and governmental services, resulting in a social value of more than $824 million in Imputed Market Price™. 

But the challenge of social determinants also requires a more systemic change in health care. That’s why earlier this year UnitedHealthcare, in collaboration with the American Medical Association (AMA), proposed an expansion of the ICD-10 billing codes used by health care providers to include social factors that contribute to patient well-being, such as food, housing, transportation and other social services.  Health care providers are key to identifying those most in need of assistance, and using the new codes would trigger referrals to social and government services that can help address an individual’s unique needs.6

The proposed new codes provide more specific diagnoses pertaining to a variety of social factors, including access to food, housing, transportation, utilities and personal caregiving needs.

“The addition of these codes would create a standard means to identify and address barriers to care and provide a consistent way for care providers and payers to share information,” said Sheila Shapiro, senior vice president of National Strategic Partnerships for UnitedHealthcare. “More importantly, they will help move health care from a diagnosis-focus to a whole-person approach to care.”

Learn more on how UnitedHealthcare addresses social barriers affecting access to care.


County Health Rankings Model,, March 2016. 

Optum® CommunityHealth and Health Care Action Council, 2018 “Community Health Data: Improving Employer Investment in Overall Employee Health”.

Optum Labs, 2019 “Optum® CommunityHealth” PPT.

UnitedHealth Group March 26, 2019 news release: “UnitedHealthcare’s Investments in Affordable Housing to Help People Achieve Better Health Surpass $400 Million”.

Need UHG source for MedTrans acquisition: National MedTrans; info from “UnitedHealthcare-AMA Collaboration Key Messages and Q&A”, April 1, 2019.

UnitedHealth Group April 2, 2019 news release: “UnitedHealthcare and AMA Collaborate to Understand and Address Social Barriers Preventing People’s Access to Better Health”.

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