Tracing value from social determinant solutions

We develop and illustrate a framework to trace value from social determinants of health (SDOH) interventions across 4 dimensions: health, cost and quality, engagement, and equity. To provide context, we begin by estimating the societal value lost to premature deaths from homelessness and food insecurity, using recent longitudinal methods that offer greater precision. We then apply the value tracing framework to 2 example interventions: permanent supportive housing for chronically homeless people and medically tailored meals for dual eligibles. These examples are supported by a narrative review of relevant literature, highlighting evidence from high-quality studies of SDOH projects that often show a broader range of benefits to multiple stakeholders. Prior research frequently overlooks non-healthcare savings, concluding that interventions "don't pay for themselves." In contrast, our findings show that when all beneficiaries are considered, many SDOH interventions yield a net positive value. Recognizing the public good nature of SDOH interventions is essential for reaching accurate policy conclusions. This paper advocates for greater recognition and estimation of the multiple sources of value in payment policies and investment decisions. Additional SDOH interventions and practical examples for local coalitions are provided in appendices.