Consider Social Determinants of Health When Offering Benefits

Employers are becoming more aware that social factors, such as where employees live, what food they have access to and how much money they make, can significantly affect workers' health and well-being. These and other so-called social determinants of health (SDoH) are closely associated with health outcomes, especially among lower-income workers and those from historically marginalized groups.

In February, the nonprofit Northeast Business Group on Health (NEBGH), representing employers that sponsor health benefit plans, released Social Determinants of Health: A Guide for Employers, to help HR and benefits leaders identify and address the health-related social needs of employees and their families.

"Employers have routine, frequent contact with their employees, determine what benefits employees can receive, and can access information that may point to social needs affecting employee health, well-being and productivity at work," said NEBGH CEO Candice Sherman.

The 48-page guide lists the main SDoH as:

• Economic stability.
• Education access and quality.
• Health care access and quality.
• Neighborhood and environment.
• Social and community context.

Employers can take steps to address the social needs of their employees by:

• Collecting data using a health risk assessment tool or an employee survey.
• Assessing benefits designs with equity in mind.
• Providing health benefits education and financial counseling.
• Reviewing what benefits might not be offered (e.g., caregiving, tuition reimbursement).

"Employers have too much at stake not to pay more attention to social determinants of health," Sherman said.

Social Factors and Obesity

Social disadvantage is associated with a higher likelihood of being overweight, according to a new study in Obesity, the journal of the nonprofit Obesity Society.

The study, Social Determinants of Health and Obesity: Findings from a National Study of United States Adults, was published in the journal's February 2022 issue. The key finding was that cumulative social disadvantage, denoted by a higher SDoH burden, was associated with increased levels of obesity.

"It is crucial for us to address [SDOH] if we want to begin to address the complex multifactorial disease that is obesity," said Dr. Fatima Cody Stanford, an obesity medicine physician scientist at Massachusetts General Hospital and Harvard Medical School in Boston.

Linking Benefits to Social Determinants

Understanding the SDoH that employees are living with can help determine if employees are enrolled in the right benefits plans, according to a Feb. 23 webcast sponsored by The Conference Board, a business research and membership organization in New York City.

Jennifer Jones, population health practice leader at Springbuk, an Indianapolis-based provider of health data analytic services, encouraged employers to use employees' SDoH to evaluate the appropriateness of benefits offerings.

"It's about asking the right questions to discover where your benefit gaps are and to direct strategies to address those gaps, using your core and ancillary benefits," Jones said.

Some of the questions she proposed are best answered through anonymous health risk assessment surveys. Answers to others can be found by analyzing payroll/HR information systems data, disability data, aggregated 401(k) data from plan record keepers, and aggregated health claims data from insurers or third-party administrators.

In addition, outside data sources can be used, such as government statistics for the neighborhoods where employees live.

The SDoH questions Jones suggested included the following:

Health Care

• What percentage of wages are going to health care premiums and/or out-of-pocket expenses?
• What services/prescription drugs are driving out-of-pocket expenses?
• What percentage of employees rely on disability income?

Benefits that can help: limiting health care cost-sharing or funding health savings accounts or health reimbursement arrangements.

Retirement Savings

• What is the average deferral percentage for retirement plans?
• What percentage of employees are taking hardship withdrawals?

Benefits that can help: employer contributions to 401(k) or other retirement accounts.

Child care

• What percentage of employees are parenting infants, toddlers, preschool and school-age children?

Benefits that can help: employer-sponsored or subsidized child care services.

Neighborhoods and Transportation

• What percentage of employees have reliable transportation to get to work?
• What percentage are living/working in high-crime areas?

Benefits that can help: work from home policies; help with setting up a home office; subsidized commuting costs.

Food Access

• What percentage of employees live in a nutritious-food desert?
• What percentage live in a fast-food swamp?
  

Benefits that can help: nutrition counseling, healthy food deliveries and nutritious meals served at work.

Personalized Benefits

During The Conference Board's webcast, Tracy Allie-Hernandez, HR senior manager at Allstate Insurance Co. in Northbrook, Ill., described how the firm's Choice Dollars benefits program addresses social factors affecting employees' health and well-being.

For employees who don't need to be on the employer-sponsored health plan—for instance, if they're covered by their spouse's plan—the Choice Dollars program provides them with funds they can spend on other benefits that best address their needs, such as contributions to a 401(k) or HSA, child care expenses, student loan repayments, or pet insurance premiums.

"We're investing in our employees in a way that's more equitable and making sure we're offering them the choice in how they spend their money," Allie-Hernandez said.

Another way Allstate is addressing SDoH is by providing access to telehealth, which can be crucial for employees with limited access to locally available health care. For employees without a primary care physician, the company provides a voucher to go to local Labcorp facility for an annual blood panel analysis.

"Removing barriers is the goal to make sure employees have access to health services in the ways they feel most comfortable using," Allie-Hernandez said.

Related SHRM Article:

Employers Tackle Social Factors Imperiling Workers’ Health, SHRM Online, April 2019