SDOH Then and Now: Building a GTM Strategy That Works
Updated: Sep 3
SDOH Solutions Have Moved Beyond Referrals. Buyers Now Expect Outcomes.
Social determinants of health solutions used to have a relatively straightforward job: identify an unmet need.
Find the member who lacks reliable transportation. Screen for food insecurity. Surface housing instability. Give care teams a better way to understand what is happening outside the exam room.
That was meaningful progress. But it is no longer enough.
Over the past decade, the market for social determinants of health (SDOH) solutions has moved through several stages of maturity. Buyers have progressed from asking whether a solution can identify a need to whether it can help resolve that need, demonstrate measurable outcomes, and ultimately prove an economic return.
For HealthTech companies building in this space, that evolution fundamentally changes the go-to-market strategy.
The product may address an important social need. The mission may be compelling. The technology may make referrals easier. But healthcare buyers are increasingly evaluating something more specific:
Can this solution solve a business problem, fit into existing workflows, produce measurable outcomes, and show where the money comes from?
That is the standard SDOH companies increasingly have to design and sell against.
The SDOH market has gone through four generations
The evolution of buyer expectations can be understood as four broad generations.
The first generation focused on identification. Healthcare organizations needed better ways to understand which members or patients had unmet social needs. This created demand for resource directories, screening tools, and technologies that could identify needs such as food insecurity, transportation barriers, or housing instability.
Then buyers encountered the obvious next problem.
Identifying a need does not resolve it.
The second generation therefore moved toward activation and closed-loop referrals. If a patient needed transportation, could the organization actually connect that patient to a resource? Could it determine whether the patient received the service?
That sounds simple until it meets the reality of healthcare delivery.
Community organizations, health systems, government agencies, and managed care organizations often operate on different technology platforms with different workflows and different levels of capacity. Resource information changes. Staff members have limited time. Even maintaining accurate information about whether a community organization can serve a particular patient can become operationally difficult.
Sending a patient to a resource with outdated information can actively erode trust. A referral platform is only useful if the network behind it actually works.
That led to the third generation: proof of value.
Buyers began asking whether completing the referral actually changed anything.
Did transportation assistance increase appointment adherence? Did medically tailored meals improve recovery? Did an intervention affect utilization, clinical outcomes, or cost?
Now the market is moving further still.
In the fourth generation, buyers increasingly expect vendors to help orchestrate the intervention from identification through outcomes, with a credible economic case attached.
That means an SDOH company is no longer competing solely on its ability to find or refer a patient.
It is competing on its ability to produce a result.
A good social intervention is not automatically a good healthcare investment
One of the hardest commercialization problems in SDOH is what economists call the wrong pocket problem.
An organization may recognize that a preventive intervention benefits a patient while still deciding not to pay for it because someone else may capture the financial return.
For a health plan, the question might be: Why invest today if the member switches plans before the savings materialize?
Demi encountered exactly that objection while working inside managed care. The assumption within the organization was that Medicaid members moved rapidly between plans and programs, making longer-term preventive investments difficult to justify.
Instead of accepting the assumption, she examined the plan's Medicaid population.
The analysis found turnover was more than three years, rather than the three-, six-, or nine-month period people had assumed. That changed the internal business case and helped secure budgets for programs with longer timelines to ROI.
The lesson for innovators is bigger than that individual example.
A buyer objection may sound like a market truth when it is actually an untested assumption.
The strongest business cases identify the assumption underneath the objection and bring evidence against it.
That could mean demonstrating how long a target population remains enrolled. It could mean identifying a quality metric affected by the intervention. It could mean showing that the solution improves revenue rather than only reducing costs.
The economic logic has to match the buyer's actual business.
ROI is not one number
Founders frequently talk about ROI as though it were a single calculation attached to a product.
Healthcare buyers do not necessarily experience it that way.
ROI changes depending on when it is measured, how the solution is priced, and which population receives the intervention.
A program requiring a large upfront investment may initially generate negative ROI before reaching a break-even point. A different pricing structure, such as a PMPM model, changes that curve.
Population selection matters just as much.
Deploying an intervention broadly across a general population may make it difficult to generate positive ROI. A more targeted intervention for a complex or acute population may produce measurable financial value more quickly.
That has direct implications for pilot design.
Instead of beginning with, “How many people can we enroll?” innovators should be asking:
Which population gives us the clearest opportunity to demonstrate measurable value? What costs will the buyer incur upfront? How quickly could the intervention affect utilization, quality, revenue, or outcomes? What evidence will be available to prove that effect?
This is also why a published study showing that a type of intervention works may no longer be sufficient.
Buyers increasingly want evidence that your intervention works for their population and affects the metrics they care about.
The webinar highlighted the value of actuarial support here. Adding actuaries to the team has helped with payer contracting by strengthening the validation of ROI assumptions and the ability to articulate the economic case.
The commercialization question has shifted from “Is there evidence behind this category?” toward “Can we credibly model and then demonstrate the value of this specific intervention?”
Narrower interventions can create stronger business cases
There is a natural temptation in SDOH to solve everything.
Screen for food, housing, transportation, personal safety, financial insecurity, and other needs. Build a comprehensive resource network. Connect everyone to everything.
Operationally, that ambition can work against the solution.
A health system screening across ten domains may need relationships with dozens of community organizations to provide meaningful coverage. Those organizations need accurate information. Referrals need to be tracked. Data needs to flow between systems. Staff members need to incorporate another process into already constrained workflows.
The broader the intervention becomes, the harder it can be to maintain quality and measure what actually produced an outcome.
There is a more focused alternative. Identify a specific population and problem, such as Medicaid members with frequent emergency department utilization who may benefit from employment assistance.
That narrower scope can make partnership development, data exchange, measurement, and implementation more manageable.
It can also make the economic story clearer.
This same principle applies to workflow.
One health system Joe encountered reserved closed-loop referrals for roughly the highest-risk 5% of patients rather than expecting staff to use the same high-touch process for everyone. Rising-risk populations needed a different, lower-touch approach because medical assistants, social workers, and physicians simply did not have the capacity to perform the same intervention across the entire population.
The best solution on paper can fail if delivering it requires work the healthcare organization cannot realistically absorb.
Designing for healthcare means designing for constrained capacity, not an ideal workflow.
“We sell to health plans” is not a market strategy
Even organizations that look similar from the outside can have very different priorities.
Joe described working with one health system that cared deeply about social worker productivity and reducing variation between staff members. Another seemingly similar system was much more concerned about its inability to reach enough patients or quantify unmet need.
The same variation exists among national payers.
A solution cannot assume that every large payer has the same population, economics, priorities, or internal budget structure.
That means the target market should not simply be “national payers,” “Medicaid plans,” or “health systems.”
The better question to ask, is where does the environment make this particular solution economically and operationally viable?
The answer may depend on state policy, available funding, social care infrastructure, claims access, community capacity, reimbursement mechanisms, or the buyer's current financial pressure.
The webinar offered a useful example in closed-loop referral infrastructure. Different states have taken different approaches to building social care infrastructure. Some have pursued common statewide infrastructure, others regional models, while others have allowed managed care organizations to select their own platforms.
Those differences matter enormously to a company trying to enter the market.
SDOH companies therefore need to evaluate markets not only by the size of the population with a need, but by whether the surrounding ecosystem makes that need solvable.
Follow the funding before building the pitch
The good news is that social care has become more institutionalized within healthcare.
The webinar pointed to Medicaid Section 1115 waivers, health-related social needs frameworks, Medicare Advantage supplemental benefits, and programmatic spending as examples of increasingly established funding pathways for certain non-medical services.
But the existence of funding somewhere in healthcare does not mean every buyer has the same ability or incentive to use it.
That makes “follow the money” one of the most practical principles for an SDOH go-to-market strategy.
Before approaching a buyer, determine which funding mechanism could realistically support the intervention.
Could it connect to quality dollars?
Supplemental benefits?
A defined programmatic budget?
An innovation budget?
A state-supported community program?
And where possible, look beyond cost reduction alone.
A solution that improves quality performance or contributes to revenue can create a different conversation from one that promises only future savings. Risk-adjustment solutions is an example of why this matters: products capable of contributing to a health plan's top line naturally attract attention because the financial incentive is direct.
The closer the value proposition gets to a financial metric the buyer already owns, the less translation the buyer has to do.
The modern SDOH pitch starts with the buyer's problem, not the social need
The framework that emerges from this evolution is straightforward, even if executing it is not.
Choose the right buyer. Solve a current business problem. Build around real workflows. Identify the funding pathway. Prove causality and economic value. Design for the complexity required to scale.
Most importantly, sell the outcome rather than the activity.
A referral is an activity.
A screening is an activity.
A completed assessment is an activity.
The buyer increasingly wants to know what happened because of those activities.
Did behavior change? Did the patient receive the service? Did utilization change? Did quality improve? Did the intervention reduce cost or contribute to revenue? Can the result reasonably be attributed to the solution?
That is a much higher standard than the SDOH market faced a decade ago. It is also a sign of a more mature market.
For founders, the strategic question is no longer simply whether healthcare recognizes the importance of social determinants of health.
The more useful question is whether your company can connect a social need to a healthcare buyer's existing economics, workflows, funding, and measurable outcomes.
That connection is where an important mission becomes a viable market.
About the Speakers
Joe Hinderstein, MHCI
Founder, Joseph Hinderstein Healthcare Consulting
Joe is a healthcare go-to-market strategist with experience selling to health systems, national health plans, state agencies, employers, pharmaceutical companies, and public health organizations. He now advises healthcare companies on sales strategy, revenue operations, and navigating complex buyer relationships, with expertise spanning value-based care, health equity, and women’s health. Connect with Joe on LinkedIn.
Demi Radeva, MSc
Founder and Chief Strategist at Akros Advisory
Demi has more than a decade of experience across Medicaid, Medicare, and Commercial health plans, including leadership roles at UnitedHealthcare and Optum. She now advises HealthTech companies on reimbursement, payer strategy, market access, and commercialization. Connect with Demi on LinkedIn.
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