SFHSS 2023 risk‑score report flags musculoskeletal conditions, cancer and racial disparities

The San Francisco Health Service System on Monday presented its 2023 risk‑score report, a claims‑based analysis staff said is designed to validate plan underwriting and to guide targeted population health interventions.

Ryn Coleridge, director of enterprise systems and analytics, summarized the findings: the top five contributors to the system’s risk score were musculoskeletal disorders, neoplasms (cancers), cardiovascular disease, diabetes and mental‑health conditions. “Population has not changed much year to year, and we still have those same top 5 conditions,” Coleridge said.

Staff highlighted distributional findings: about 2% of the non‑Medicare membership drives roughly 36% of total costs, and musculoskeletal disorders are the single largest contributor across risk bands. The presentation also singled out racial disparities: Black members showed higher average risk scores across age bands and plan populations, and staff said they will use those findings to inform targeted outreach and phase‑2 work under the racial equity action plan.

The report examined social‑determinants‑of‑health coding trends, noting most SDOH diagnosis codes used by the plans fall under social and community context (life‑transition events, relationship issues, housing/economic items). Coleridge said CMS continues to release new SDOH codes and that carriers vary in how consistently they capture and report this information.

Board members asked how the analytics could inform earlier intervention: commissioners discussed the potential to identify cancers detectable by screening and musculoskeletal self‑care programs to reduce progression to higher‑cost care. Coleridge and other staff said claims data have limits and emphasized partnerships with health plans to access richer clinical data for targeted programs.

The board did not take a vote on the report; staff said the risk‑score findings will be used to prioritize member outreach, plan performance guarantees and future measurement work.