The employer’s guide to addressing Social Determinants of Health

Barriers to care across the commercially-insured population

Social determinants of health (SDoH) are the economic and social conditions that influence almost every aspect of an individual’s care, impacting both health status and health outcomes across a broad spectrum of conditions. SDoH conditions, such as access to nutritious food, healthcare resources, and education, can drive as much as 80% of health outcomes.

According to the study, Social Determinants of Health Challenges Are Prevalent Among Commercially Insured Populations, 27% of the commercially insured population studied live in ZIP codes at or below 200% of the federal poverty level. The study also found that 26% reported family, school or work responsibilities as obstacles to accessing care and 55% reported cost is a major barrier to care. 

In other words, many employees are quietly struggling to balance basic needs with their health—and often, healthcare loses out.

These stats justify the need to more comprehensively identify social barriers that adversely affect employee health and to address them with relevant programs and interventions. Without access to the resources they need to stay healthy, many people with SDoH barriers to care are forced to make healthcare decisions with limited options. They’re more likely to avoid or delay care, engage in unhealthy behaviors, and experience diminished physical health and behavioral health, including higher rates of chronic disease.

The employer role

Many employers already provide generous benefits, and they have continue to grow every year. Despite these efforts, lack of engagement with employer-sponsored benefits programs continues to be a challenge. You are uniquely positioned to remove barriers to care, not only by offering strong benefits, but by ensuring those benefits are accessible, equitable, and clearly understood. In addition, you can further reduce barriers to care by revisiting your overall benefits design, wellbeing program offerings, physical environment (including onsite and near-site clinics), wages, and organizational policies.

When you are implementing programs that help your population overcome SDoH barriers to care, you have the opportunity to: 

• Close gaps in care and improve health outcomes 
• Reach vulnerable communities 
• Increase engagement with health benefits programs 
• Build and retain a competitive workforce

These three steps to benefit program design are intended to help employers comprehensively address SDoH barriers among their employees. Recognizing that there is no one-size-fits-all solution for all employers, this guide is designed to help you determine what your employees need most and what the company is able to do to address those needs.

Benefits plan design

To start addressing social determinants of health barriers in your population, you can begin with an assessment of the barriers employees are facing, how current benefits design helps overcome those barriers, and what components might be missing.

Step 1: Identify vulnerable employee populations and possible gaps in care

The data you already have can provide key insights into populations at greatest risk for SDoH barriers to care.

Employee data:

• Zip code of residence (which can be used in conjunction with the publicly available data listed below to identify at-risk households)
• Race/ethnicity
• Income
• Eligibility data, including household size and composition
• Healthcare claims
• Utilization of no- and low-cost employer-sponsored programs

Publicly available data that can be used to map employee populations to common SDoH barriers include:

• Health status by zip code from the CDC
• Food access by zip code from the USDA (e.g., Food Environment Atlas)
• Income by zip code from the U.S. Census Bureau (e.g., Small Area Income and Poverty Estimates)
• Provider deserts from the HRSA (e.g., Health Professional Shortage Area)

Employee health assessments provide data on employee health status and can be expanded to include questions that assess for common barriers to care. For example, Castlight’s yearly health risk assessment includes questions like: “in the past 12 months have you had trouble paying for basics like food; housing or medical care?” Surveys should be confidential so employees feel more comfortable participating and answering honestly. Use of a third-party survey administrator can be helpful in this regard.

Together, this data can help identify vulnerable populations such as:

• People with diabetes who live in a food desert
• People not taking their medications as prescribed who live in a high-poverty zip code
• People with high-risk pregnancies living in maternity provider deserts
• People lacking a PCP or who have missed preventive screenings who live in a high-poverty zip code

What does this look like in real life: In Q1 2025, Castlight’s health risk assessment revealed eye-opening results from large organizations across the country including many Fortune 500 companies: 36% of respondents reported needs tied to social determinants—most commonly the inability to afford basic necessities, and 6% said they felt physically or emotionally unsafe or at risk of self-harm. With this knowledge, Care Guides can proactively guide these employees to available employer-sponsored benefits and resources provided by their community (e.g., community-supported food bank).

Once you understand the needs of your population, evaluate the gaps between what is needed and what is already being provided through current or planned benefits—in addition to what the engagement level is for all currently available programs and resources. Are they being used, and are the employees who could benefit most from them already engaging?

Step 2: Evaluate organization’s culture of health

Employers should specifically assess their:

• Health insurance offerings (one-size-fits-all vs. income-based options)
• Organizational policies (time off, sick leave, disability)
• Physical environment (healthy food options, demanding working conditions)
• Implicit biases among leadership (unknowingly treating employees differently based on their age, weight, race, gender, sexual preference, etc.)

Ask yourself: “Do our current policies and programs unintentionally make it harder for some employees to access the care they need?”

Step 3: Fill in the gaps

Once you have identified and evaluated it’s time to start filling in the gaps to address needs. Some ways to do that are:

• No- and low-cost benefits programs
• Pay-based health plan premiums, deductibles, and co-insurance
• Local community resources (e.g., community food banks and support groups)
• Updates to business policies (e.g., allowing flexible or remote work, increasing time off for medical appointments, and providing necessary job accommodations)
• High-touch services to help those with complex needs or who are less comfortable with digital solutions

What could this look like in real life: Pay-Based Health Plans. The lower the income, the lower the premium payment is. For example, employees making less than $25,000 contributed $0 per week while those with an income between $50,000-$75,000 paid $90 per week.

Your benefits only create value if employees can actually use them. Unaddressed social determinants widen health disparities, drive up avoidable costs, and erode trust in employer-sponsored benefits. Addressing social determinants of health is no longer a “nice to have”, it’s central to improving population health, retention, and wellbeing. In fact, according to Business Group on Health 59% of employers are expanding their efforts in addressing social determinants of health in the next few years. 

The message is clear: employers who act now to address SDoH will build healthier, more resilient, and more engaged workforces. The time to rethink benefits design is here, because when employees have the support they need to thrive, businesses thrive too. 

Request a demo today to learn how Castlight can help your organization address social determinants of health in your benefits design.