Social Determinants of Health
Social Determinants of Health (SDoH) is the Salesforce Health Cloud data model that captures the non-clinical factors influencing a patient's health outcomes: housing stability, food security, transportation access, financial strain, education, employment, social support, and community safety.
Definition
Social Determinants of Health (SDoH) is the Salesforce Health Cloud data model that captures the non-clinical factors influencing a patient's health outcomes: housing stability, food security, transportation access, financial strain, education, employment, social support, and community safety. The model is built on a set of standard objects (HealthCloudGA__SDoHIndicator__c and related) that record each domain's status, severity, and source for every patient or member.
Social Determinants of Health surfaced in U.S. healthcare policy around 2018 and became a Health Cloud first-class data model in the Winter 21 release. Care teams use it to identify patients whose clinical care is being undermined by social conditions (a diabetic patient skipping medication because they cannot afford it, an elderly patient missing appointments because they have no transportation), then connect them to community resources (food banks, transportation services, financial assistance programs). The data model also feeds risk stratification, care plan personalization, and value-based-care reimbursement analytics.
Why Social Determinants of Health became a first-class Salesforce Health Cloud model
The eight SDoH domains
Health Cloud's SDoH model captures eight domains aligned with the U.S. Department of Health and Human Services Healthy People 2030 framework. The domains are Housing Stability (homelessness, eviction risk), Food Security (food insecurity, nutrition access), Transportation (access to medical appointments, public transit), Financial Strain (medical debt, ability to afford medication), Education (literacy, health literacy), Employment (job stability, sick leave access), Social Support (isolation, family connections), and Community Safety (violence exposure, neighborhood conditions). Each is a separate set of records tied to the patient.
The data model
Each SDoH observation is a record on the SDoHIndicator object (HealthCloudGA__SDoHIndicator__c in some package versions). The record carries the patient (Account or Person Account), the domain (Housing Stability, Food Security), the status (Stable, At Risk, In Crisis), the severity, the assessment date, and the source (provider assessment, patient self-report, screening tool). Care plans reference these records to drive interventions; risk scores aggregate them into a patient-level vulnerability index.
Validated screening instruments
The SDoH model integrates with validated screening instruments: PRAPARE (Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences), AHC-HRSN (Accountable Health Communities Health-Related Social Needs Screening Tool), and others. A care manager runs the screening with the patient (during intake or annual wellness visit), the platform creates an SDoHIndicator record per identified need, and the record persists across the patient's care episodes. Standardized instruments make the screening repeatable and the data comparable across populations.
Care plan integration
Identified SDoH risks feed directly into the patient's Care Plan. A patient flagged with Food Insecurity gets a care plan goal (Connect to local food bank) and a care plan activity (Outreach to St. Mary's Food Pantry). The Care Plan object links to the SDoHIndicator that triggered the goal, so the care manager can show the patient and the regulator how the social risk drove the plan. This linkage is what differentiates Health Cloud from a generic CRM in healthcare contexts.
Community resource referral
Salesforce Health Cloud includes a Community Resource Referral feature that lets a care manager refer a patient to a community service (food bank, housing assistance, transportation provider). The referral creates a new record linked to the SDoHIndicator, tracks the outreach, the connection, and the outcome. Many health systems integrate Aunt Bertha, NowPow, or other community resource directories so the care manager can search and refer without leaving the Salesforce console.
Risk stratification and population health
Health systems with value-based-care contracts use SDoH data for risk stratification: which patients are most likely to be hospitalized, miss follow-ups, or have poor outcomes. The SDoHIndicator records aggregate into a patient-level Social Vulnerability Index that combines with clinical risk factors (chronic conditions, recent hospitalizations) to produce a holistic risk score. The score drives outreach prioritization, intervention spend, and ACO (Accountable Care Organization) shared-savings analytics.
Reimbursement and value-based-care
Capturing SDoH data is increasingly tied to reimbursement. CMS (Centers for Medicare and Medicaid Services) introduced Z codes for ICD-10 to capture social determinants in clinical billing, and several state Medicaid programs reimburse for SDoH screening and intervention. Salesforce Health Cloud captures the data structurally so the health system can demonstrate screening compliance, intervention follow-through, and outcome improvement, which feeds value-based-care contract performance and shared-savings calculations.
Record an SDoH screening result for a patient
Use Salesforce Health Cloud to capture an SDoH screening, create indicator records per identified need, and link them to the patient's care plan.
- Open the patient record
Navigate to the patient (Person Account or Account in Health Cloud). The Patient Card view shows demographics, conditions, and SDoH summary.
- Launch the SDoH screening flow
Click the SDoH Screening quick action. The flow walks the care manager through the validated instrument (PRAPARE, AHC-HRSN) with structured questions.
- Capture responses
Enter the patient's answers for each domain (housing, food, transportation, etc.). Indicate severity where the instrument supports it.
- Submit
On submit, the flow creates one SDoHIndicator record per identified risk and updates the patient summary. Records with no risk are noted as Stable.
- Review identified needs
Open the SDoH related list on the patient record. Confirm each risk has the expected severity and status.
- Create care plan goals
For each high-severity risk, add a Care Plan Goal linking back to the indicator. Optionally trigger a Community Resource Referral.
- SDoH data is sensitive. Many states have laws restricting how social-risk data can be shared or used in coverage decisions; confirm your compliance program before exposing the data outside the care team.
- Screening fatigue is real. Repeating PRAPARE every visit annoys patients and produces stale data; most programs screen annually plus on major care transitions.
- Community resource directories drift. The food bank you referred to last year may no longer exist; refresh the integrated directory quarterly.
- Risk stratification scores are easy to compute but only useful if intervention follow-through is tracked. A high score with no follow-up is a checkbox metric, not a care plan.
Trust & references
Cross-checked against the following references.
- Social Determinants of HealthSalesforce Health Cloud Help
- Salesforce Health CloudSalesforce
- Healthy People 2030: SDoHU.S. Department of Health and Human Services
Straight from the source - Salesforce's reference material on Social Determinants of Health.
- Health Cloud SDoH DocumentationSalesforce Help
- Care Plans in Health CloudSalesforce Help
- Community Resource ReferralsSalesforce Help
Hands-on resources to go deeper on Social Determinants of Health.
About the Author
Dipojjal Chakrabarti is a B2C Solution Architect with 29 Salesforce certifications and over 13 years in the Salesforce ecosystem. He runs salesforcedictionary.com to help admins, developers, architects, and cert/interview candidates sharpen their fundamentals. More about Dipojjal.
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