ACG GeoHealth: Using social determinants of health to drive a successful population health strategy

The Johns Hopkins ACG® System—the world’s leading population health analytics software—is greatly enhanced with the integration of Social Determinants of Health (SDoH), which allows users to craft a solid population health strategy more accurately and intelligently.
Working alongside the ACG System’s Social Need Markers (SNM), ACG GeoHealth is a unique component that enhances your organization’s existing data. Adding these SDoH features provides a comprehensive population-and individual- level view of social risk, and gives you results that cannot be obtained through other methods.

How can ACG GeoHealth help you meet your goals?

ACG GeoHealth incorporates SDoH risks related to geography, or where the population being analyzed is located. By building on the ACG System’s whole-person approach to health needs and predictive measures, ACG GeoHealth provides System users with cleansed, curated data, providing in-system capabilities to:

  • Identity disparities in health status for populations based on the area in which they live
  • Measure health disparities, outcomes and cost-based geographic variables
  • Develop needs-based plans to provide essential care in a geographically targeted way
  • Support resource allocation, case management and community health worker activities
  • Understand disease prevalence, quality of care and utilization trends by geography

What are the ACG GeoHealth measures?

ACG GeoHealth’s measures were specifically selected to add value to population health and risk-based analyses, provide complete population data and generate helpful information to understand SDoH needs. Within the initial ACG GeoHealth release, 17 unique variables are calculated and presented at a patient level, alongside pre-existing ACG System variables. ACG GeoHealth provides many opportunities to enhance existing ACG System use cases and applications. End users can now integrate socio-environmental factors and clinical features into the management and understanding of patient populations.
ACG GeoHealth Measurements 

The Strategic Value of ACG GeoHealth

When it comes to health care, it truly matters where people live, work and play. SDoH contributes to health disparities and inequities, increased health risk and poor outcomes. Solving for SDoH cannot be done alone by any one organization, health system or health plan. We understand that ACG System users require nuanced, focused data outputs to help prioritize social needs within their populations, drive strategic investment decisions and plan tactical support for their strategy.

Using ACG GeoHealth’s measures, you will be able to:

  • Understand the impact of SDoH on your population’s health status, disease frequency, and outcomes
  • Formulate a strategy to address these factors and drive action
  • Gain a deep understanding of SDoH with minimal adjustment to your current ACG processing
  • Benefit from SDoH and population health expertise from the experts at Johns Hopkins

ACG GeoHealth Use Case:

A large health organization wants to re-focus their philanthropic efforts on specific SDoH needs. They choose food insecurity and health inequity, which are predictors of poor future health outcomes. An analysis using ACG Geo Health markers allows the organization to identify geographical areas in which food insecurity is highest in their area. Then, they can more precisely allocate funding to local non-profits specializing in food insecurity and health inequity measures (annual well visits, vaccinations, etc.). Also, the organization can work with local physician groups and health systems to better address geographical needs and organize collaborative efforts such as pop-up clinics.

ACG GeoHealth is an optional, strategic feature of the ACG System, for users who want to understand their entire population, versus the more traditional view of just clinical data and utilization trends.

Fully meeting a community’s social needs requires teamwork between key stakeholders. The addition of ACG GeoHealth to the existing suite of ACG System tools is a significant advancement to help users achieve better health outcomes, reduce disparities and better serve their populations.

About the Johns Hopkins ACG® System

The ACG System is a flexible, transparent set of tools developed and validated by scientists and clinicians at the Johns Hopkins Bloomberg School of Public Health. The ACG System is used by Medicare, Medicaid and commercial health plans in the U.S., health care providers, and technology companies. Customers use the ACG System to segment their patient populations and to process their organization’s existing medical, pharmacy and lab data to generate clinical risk markers and predictive models at the population and patient level. The ACG System provides health care analytics teams with rapid decisions about patient care, resource planning and service design.

SS&C Health is the exclusive distributor of the Johns Hopkins ACG System for health plans in the US. To learn more visit

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