Predictive Value of Screening for Addressable Social Risk Factors




To evaluate whether a screening assessment tool that identifies
medical and social risk factors is predictive of healthcare costs in the
absence of claims data. To evaluate the effectiveness of screening
for social factors to target high cost beneficiaries.

Study design

A retrospective study evaluating medical and pharmacy claims
costs a year after the behavioral and social risk assessment was


We analyzed medical and pharmacy claims, medical and social
risk assessment information, and patient enrollment data for 7,762
newly-eligible Medicaid adults. We controlled for age, gender, and
common chronic diseases. We performed multivariable regressions
across cost and utilization outcome measures, created risk stratification
groups and assessed hospital utilization and spending based on
the number and type of social factors.


Although many managed care networks do not systematically
collect social and behavioral risk factors in a medical setting, social
risk factors are associated with an increase in healthcare costs.
Healthcare costs were $65 Per Member Per Month higher for beneficiaries
who had trouble securing food, clothing, or housing (95%
Confidence Interval [CI], $10 to $119; P=0.02). The presence of 1-3
addressable risk factors is associated with $132 higher Per Member
Per Month spending, even when both groups reported infrequent
hospitalizations (95% Confidence Interval [CI], $77 to $188; P<0.001).


Social risk factors lead to an increase in healthcare cost and utilization
even after controlling for past hospital utilization, chronic conditions,
age, and gender. Managed care networks should routinely
screen for social factors to target at-risk patients to better manage
long-term healthcare costs.

Keywords: Care management solutions; Medicaid expansion; Social
determinants of health

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