How Payer-Led Social Needs Programs Cut Medicaid Costs
The Benefits of Payer-Led Social Needs Programs: Outcomes & Economics
Elevance Health’s Community Connected Care program shows where social needs investment pays off most: Medicaid members with both high clinical and high social risk
By ValerieCerra, GroundGame.Health
What the NEJM Catalyst Study Found
Health plans have been screening their members to identify social needs for years, but they did not always follow up or do much more than collect the data. That’s despite a growing body of evidence that health plans can leverage screening data to direct activities that reduce healthcare costs. In fact, just this year the CMS Innovation Center’s final evaluation of the Accountable Health Communities Model, which screened more than 1 million Medicaid and Medicare beneficiaries, found that navigation to community resources lowered total health care expenditures in a randomized design and generated more than $200 million in net savings (RTI International,2026). A New England Journal of Medicine Catalyst study of Elevance Health’s Medicaid program, delivered through GroundGame.Health (GGH)’s methods, further demonstrates the savings: members with both high clinical and high social risk saw $181 lower per member per month total cost of care (Elmor et al., 2026).
NEJM Catalyst examines how Elevance’s Community Connected Care (CCC) program linking members to social needs benefits achieved the following:
• $181 per member per month lower total cost of care
• $1,086 saved per member over six months, exceeding Elevance’s investment
• Statistically significant reductions in emergency department costs and increases in primary care costs for that dual risk group
The published results inform national health plan leaders, and Medicaid MCO executives in particular, about why payers are suited to lead social needs interventions and what it takes to make those programs sustainable.
Why Health Plans Are Positioned to Lead Social Needs Interventions
Broadly speaking, health plans are well-positioned to lead social needs interventions. Payers have the member base needed to scale, and the data necessary to identify high-risk members, inform personalized approaches, and confirm outcomes via encounter or claims data. They also stand to benefit by achieving higher HEDIS scores and retaining more members, which is more important than ever as many Medicaid plans are already losing members, and others are likely to do so when new work requirements take effect on January 1, 2027.
But MCOs cannot succeed alone and need to align with the right partner for local outreach, engagement, and tracking results.
What It Takes to Build a Sustainable Social Needs Interventions Program
GGH supported Elevance’s CCC by leveraging its network of community-based organizations (CBOs), national Medicaid footprint, experienced community care workers (CCWs), appropriately aligned incentives for all the stake holders, and its Implify®social care navigation platform.
With those pieces in place, Elevance identified high-risk members, and GGH assigned CCWs to develop personalized care plans for those members. CCWs engaged the member using personalized communication protocols, conducted in-depth member assessments, navigated the member through the care plan activities and maintained progress reporting until the care plan was fully executed. GGH standardized the status, progress, and engagement data and submitted it back to Elevance to close that referral loop.
A key insight from the initiative is the criticality of targeting members with clinical as well as social needs. The results speak for themselves: 100% of the ROI came from the 32% of members with both clinical and social risk.
In addition to Elevance’s success, GGH has shown it can help other health plans achieve a 20% lift in select HEDIS measures for Medicaid, a 14% increase in Medicaid member retention, and a 4.8 out of 5 average member satisfaction score.
Our Takeaways
The question is no longer whether national health plans can benefit from proactively addressing social needs. Rather, it’s how they can do so while also earning a return on the investment. (For more on why payer-led social care makes sense and the barriers to adoption, see our earlier post.)
That said, simply standing up universal screening can all too easily become just another pilot that never quite takes off. So national health plans need to be strategic about aligning with the right partner that can staff with experienced care coordinators, align local community care resources across a nationwide network, and support all of this with sophisticated social care navigation technology.
Any social needs intervention partners that cannot show tangible results will now have some explaining to do to health plan and Medicaid MCO leaders looking to undertake such programs with the confidence that they will improve outcomes for members and drive down costs for health plans.
Frequently Asked Questions
Do payer-led social needs programs save health plans money?
Yes, when they are targeted. In the NEJM Catalyst study of Elevance Health’s Medicaid program, members with both high clinical and high social risk saw $181 lower per member per month total cost of care, or $1,086 saved per member over six months, exceeding the plan’s investment.
Which Medicaid members drive the return on investment?
Members with both clinical and social risk. They made up 32% of the members in the program and accounted for 100% of the ROI.
What does a payer need from a social care partner?
Experienced community care workers, a network of local community-based organizations, aligned incentives, and technology that tracks progress and closes the referral loop with the health plan.
Ready to Build a Social Needs Program That Pays Off?
See how GroundGame.Health helps health plans reduce total cost of care. Talk to our team.
Read the full NEJM Catalyst study: Payer-Led Social Needs Interventions Can Reduce Cost of Care for Medicaid Beneficiaries with High Clinical Risk.
