For most health plans, social risk lives inside care management, disconnected from strategy and the balance sheet. The result is avoidable utilization no one has quantified and spending no one has traced to a cause.
As medical costs climb and margins tighten, that blind spot compounds. Members with the highest social risk cycle through avoidable admissions and ED visits, while the savings from addressing their needs stay theoretical — impossible to fund because no one has put a number on them. Social risk stays a talking point instead of a strategy.
BlueCross BlueShield of South Carolina changed that. Working with analytics and data partners, the plan pinpointed its highest-social-risk members, quantified the savings targeted intervention could produce and focused resources where the return was greatest. April Richardson, MD, vice president of clinical services at BCBS South Carolina, shares how the team turned social risk data into an ROI-focused strategy that informs enterprise decisions, strengthens financial performance and improves member outcomes.
You’ll learn how to:
- Identify populations where social risk drives avoidable utilization and cost
- Quantify potential savings and build the business case for targeted intervention
- Prioritize investment where it delivers the greatest impact
- Tie social risk initiatives to measurable financial and member outcomes