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Social risk analytics: The right data for the right interventions

Courtney Yule : Published February 28, 2022 Updated November 24, 2025

Download our white paper, Using Social Risk Scores to Predict Unnecessary Healthcare Utilization.

All forward-thinking hospitals understand the role of social risk in providing effective, equitable and efficient care. In many ways, hospital objectives align with those of social risk assessment. Both help to distinguish acute from long-term needs, identify underlying contributors to poor outcomes and, wherever possible, help minimize or completely prevent more serious interventions.

Six social risk factors and their drivers

Social risk is a measure of vulnerability as defined by specific social determinants of health (SDOH). DataGen uses the following six SDOH categories.

Social Determinants of Health
Category	Defined by	Individual risk drivers	Community risk influencers
Digital	Access, affordability and literacy	Competency	Resources
Finance	Strength, resources and resiliency	Financial assets, liabilities and opportunities	Income, cost of living and opportunity
Food	Sufficient access and affordability	Healthy foods and food literacy	Same
Health literacy	Healthcare access, navigation, comprehension and adherence	Culture, demographics and education	Same
Housing	Standard of living	Stability, quality and crowding	Same + overall affordability
Transportation	Adequacy related to healthcare	Access, proximity and mobility	Access and proximity

Each category includes drivers that help calculate social risk (none to high) and prioritize need. Numerous data points and sources for each social determinant can help hospitals design interventions that transition individuals and communities from struggling to thriving.

The importance of an analytics-informed approach

Measuring social risk is new to most healthcare stakeholders. An analytics-informed approach — in addition to community partnerships — is needed to accurately identify, prioritize, measure and evaluate SDOH interventions. Such an approach also requires SDOH-specific data that are diverse, granular to the sub-ZIP code level and can be integrated with existing EHR and claims data. The result is empowered understanding for measurable return on investment, one of the most difficult SDOH objectives to achieve.

Three DataGen advantages make us the ideal social risk analytics partner:

First, we understand the unique needs of hospitals and health systems.
Second, we are able to license market-leading SDOH data and analytics from our partner, Socially Determined.
Third, our data and capabilities free up resources by integrating Socially Determined’s social metrics with your data for new and powerful insights.

These combined resources deliver a unique brand of social determinants telescoping — the ability to literally zoom in and out on healthcare needs, risks and the best responses for evidence-based ROI.

Three social risk advantages

Measuring social risk is vital to providing the right help to the right people at the right time. Social risk analytics are also the perfect companion to the Community Health Needs Assessment and can strengthen collaboration between hospitals and the growing list of partners needed to address CHNA findings. In addition, a new standard of care is emerging that links health equity to advanced payment models.

Providers must be prepared.

A recent DataGen poll showed that more than 20% of health systems are not yet involved in SDOH activities. Among those that are, measuring results and ROI is one of the biggest challenges, yet many providers have not yet moved beyond claims data or determined how to best analyze the limited information they have.

Now is the time for providers to choose empowerment through a wealth of new SDOH data and analytics. Individuals at risk and the communities they call home are counting on it.