Presentation (CTI)

OBJECTIVES: Social drivers of health (SDOH) are upstream demographic, geographic, and economic factors that influence health plan members’ access to healthcare, engagement in care, and health outcomes. We describe SDOH variables available in a large real-world database by plan type.
METHODS: We used a limited dataset from the Healthcare Integrated Research Database (HIRD®), a large administrative claims database, for this study. The HIRD includes such SDOH variables as socio-economic characteristics from the American Community Survey, food desert indicators from the Food Access Research Atlas, urbanicity from the National Center for Health Statistics, health professional shortage designations from the Health Resources and Services Administration, individual-level race/ethnicity, and a social driver score utilizing both census-level and individual-level data. The study population included all members with medical and pharmacy coverage continuously enrolled in a commercial or Medicare Advantage (MA) health plan from 01/01/2025-07/31/2025.
RESULTS: Of 14.5 million members, 81% were enrolled in non-marketplace commercial plans (mean age 36 years, 50% female); 11% in marketplace commercial plans (mean age 39 years, 51% female); and 8% in MA plans (mean age 72 years, 56% female). Approximately 16% of members lived in rural counties; rurality was highest among MA members (25%). Living in a health professional shortage area for primary care was most common among members with marketplace insurance plans (27%) versus 15% among MA members. Using two different composite measures of social drivers, most commercial members, including those with marketplace plans, were in the lower half of the social need distribution, while MA members tended to be in the higher half.
CONCLUSIONS: Many social driver variables are readily available from public sources and can be linked to claims data using members’ addresses. These data characterize health plan members’ circumstances outside clinical settings and can be used to describe variation in their access and use of healthcare.