Health-Related Social Needs in a Large Health System: Comparing Mandated to Eight Additional Domains

Abstract Background From 2024-2026, hospitals were mandated by Centers for Medicare and Medicaid (CMS) to screen for five health-related social needs (HRSN); however, patients experience additional HRSN that affect their health. Understanding all HRSN experienced among patients in large health systems is important to improve health. Objective To describe rates of patient-reported HRSN across 5 CMS-mandated, and 8 additional domains. Design We conducted a cross-sectional study of all patient HRSN screenings completed in a large health system from July 2021 to June 2023. We summarized overall HRSN rates and utilized generalized estimating equation models to determine odds of experiencing HRSN across demographics. Participants Patients from a large, Midwestern healthcare system, aged ≥ 18 years and residing in the USA ( n = 559,118). Main Measures Associations between patient demographics (sex assigned at birth, race, ethnicity, age, health insurance) and HRSN reported in 13 domains—five required by CMS (domestic violence; food, housing, and transportation insecurity; utility affordability) and eight additional domains (barriers due to physical/mental health; dependent care; employment; education; healthcare affordability; literacy; legal issues; social connections). Key Results Four non-CMS-mandated categories had higher prevalence than any CMS-mandated category (barriers due to physical/mental health, 23.6%; education, 11.4%; social connections, 10.4%; literacy, 5.3%). Black patients and patients of Other race, patients aged 18–29 and 50–64 years old, and patients with Medicare/Medicare Supplement, Dual Medicaid + Medicare, Self-pay, and Other insurance had higher odds of reporting all CMS-required HRSN. Relative odds of other HRSN varied based on demographic characteristics. Conclusions This is one of the first studies to compare CMS-mandated HRSN and additional HRSN domains from a population-wide screening program. Future research should investigate what drives reported HRSN prevalence differences and ensure successful HRSN screening and intervention implementation across population subgroups. Determining which HRSN domains should be mandated by entities like CMS is paramount to addressing patient needs impacting health.