Welcome to Aligning for Health's bi-weekly Social Determinants Updates newsletter.
In this newsletter, you will find updates on how health care organizations are striving to meet health and social needs and invest in community health to improve health equity, as well as other notable links to research, data, and news related to social determinants, and upcoming virtual events and opportunities.
Aligning for Health is thrilled to announce its newest member organization - Vizient Inc. Vizient is the nation’s leading health care performance improvement company and serves over half of the health care organizations across the US. To learn more, click here.
United Way of the Greater Capital Region: (7/22) - United Way of the Greater Capital Region and Healthy Alliance IPA, a sister organization of Alliance for Better Health, launched the Changemaker Fund to support BIPOC-led community organizations. This fund will provide critical funding and resources for 13 local organizations working to advance positive social change and address wide-ranging systemic inequities among Black, Latinx, immigrant, refugee, and rural communities.
Home Health Care News: (7/21) - Signify Health announced it has activated its Transition to Home program in over 50 hospitals across 12 states. The program allows Medicare patients to receive clinical and social care support as they transition from the hospital to the home, and is designed to reduce avoidable in-patient readmissions and emergency room visits.
American Hospital Association: (7/16) - Health care systems across the country are looking to integrate health equity goals and the elimination of disparities into their strategic playbooks. This perspective piece from the American Hospital Association (AHA) calls for this strategy to include diverse representation among leadership, specifically on hospital and health system boards, so that it reflects the communities they serve.
CareSource: (7/15) - CareSource invested $1 million towards a new partnership as part of its $6 million commitment in investments to make housing more affordable in Indiana. CareSource invested with Finance Fund Capital Corporation, which will provide access to capital to promote development in low-and moderate-income communities. CareSource also invested with Terebinth Group, which will create affordable housing solutions in the state.
Dayton Business Journal: (7/15) - Over 200,000 households in Ohio were behind on rent as of June, equating to $480 million in estimated rent debt across the state. Amy Riegel, senior director of housing at CareSource, said that the upcoming expiration of the eviction moratorium on July 31 will have a severe impact, and a “very heavy influx of evictions” is expected once the moratorium is lifted. CareSource advocates on a number of housing efforts, including the expansion of rental assistance as a key component in building stability in the future.
PR Newswire: (7/14) - Unite Us released its end-to-end social care solution to accelerate the investment and impact of social care services across the nation, and place people at the center of community-focused care. The end-to-end solution, the first created in the industry, establishes a new standard of care that identifies and predicts social care needs in communities, manages enrollment of individuals in services, and leverages meaningful outcome data and analytics to further drive community investment.
Anthem: (7/9) - Anthem, a health plan of Blue Cross Blue Shield Association, is helping to remove transportation barriers to COVID-19 vaccines for members. The health plan’s partnership with Lyft through the vaccine access program has helped provide 60 million rides to and from vaccination sites, with a focus on supporting low-income, uninsured, or under-resourced communities.
NBC 4 Washington: (7/8) - Aunt Bertha partnered with MedStar Health to assist patients and families struggling to access basic health necessities like fresh food and health care services. The tool helps patients have the connections and resources they need once they leave the hospital doors, and has helped patients like Jeffrey Jones in DC to access transportation to a grocery store following care for a heart attack since he does not drive.
Launch of the Congressional SDOH Caucus
Aligning for Health applauds Representatives Cheri Bustos (D-IL), Tom Cole (R-OK), G.K. Butterfield (D-NC), and Markwayne Mullin (R-OK) for forming the bipartisan Congressional Social Determinants of Health Caucus, which seeks to highlight opportunities for coordination across federal investments in health, public health, food, housing, transportation, and other important drivers of health.
The Caucus was officially launched during a webinar on Wednesday, July 21. Caucus members are requesting feedbackfrom stakeholders through September 21 on challenges and opportunities related to social determinants of health to help inform their work moving forward.
Forward Momentum on the Social Determinants Accelerator Act!
The House Energy & Commerce Committee, Subcommittee on Health held a markup of 19 pieces of legislation on July 15, several of which seek to provide guidance and funding, and to catalyze activities to address social determinants of health and maternal health.
The Subcommittee voted favorably to advance the bipartisan Social Determinants Accelerator Act (H.R. 2503), which will help states and communities devise strategies to better leverage existing programs and authorities to improve health and wellbeing. The bill now moves to the full Committee for consideration.
Aligning for Health is thrilled to see forward momentum on this important bipartisan piece of legislation, and we look forward to working with the Committee on its continued advancement.
House Energy & Commerce Committee: (7/21) - The House Energy & Commerce Committee advanced 16 health care bills to be considered by the full House of Representatives. Included in these bills are several pieces of legislation related to social determinants of health and maternal health: Social Determinants of Health Data Analysis Act of 2021 (H.R. 4026); Maternal Vaccination Act (H.R. 951); Maternal Health Quality Improvement Act of 2021 (H.R. 4387); and the CARING for Social Determinants Act of 2021 (H.R. 3894).
Health Enterprise Zones Act: (7/20) - Rep. Brown (D-MD) and six cosponsors introduced the Health Enterprise Zones Act (H.R. 4510), which would provide for the designation of areas as Health Enterprise Zones to reduce health disparities and improve health outcomes in such areas. The bill would close gaps in the health care system that have left behind minorities and underserved communities by creating incentives to improve health care access, public health and attract health care practitioners to work in health-disadvantaged communities.
Care That’s Fair Act: (7/20) - Reps. Butterfield (D-NC) and Joyce (R-PA) introduced the Care That’s Fair Act of 2021 (H.R. 4554), which would provide grants to support for States to identify and act on racial disparities. Specifically, the bill will empower states, through grant funding from CMS, to utilize medical claims, clinical data, and social data to address racial disparities, social determinants of health, and maternal and infant mortality.
Coordinating Assistance for TANF Recipients Act: (7/20) - Reps. Walorski (R-IN) introduced the Coordinating Assistance for TANF Recipients Act (H.R. 4543), which would provide for the conduct of demonstration projects to provide coordinated case management services for TANF recipients. It would allow states to test methods of coordinating case management between multiple programs for such individuals and their families.
Fighting Homelessness Through Services and Housing Act: (7/15) - Sen. Feinstein (D-CA) and six cosponsors introduced the Fighting Homelessness Through Services and Housing Act (S.2357), which would fight homelessness in the United States by authorizing a grant program for housing programs that offer comprehensive services and intensive case management for homeless individuals and families. Rep. Lieu (D-CA) introduced companion legislation in the House (H.R. 4464).
FY2022 Labor-HHS Appropriations: (7/15) - The House Appropriations Committee approved the fiscal year 2022 funding bill for HHS. Accompanying report language outlines significant funding and support for addressing social determinants of health. Notably, the Committee matched President Biden’s request of $153 million for CDC’s Social Determinants of Health program, a portion of which will continue to go toward expanding and implementing Social Determinants Accelerator Grants. The Committee also included instructions for HHS to continue to implement the interagency Social Determinants Accelerator Council. A summary outlining included SDOH proposals can be found here. Bill Summary
House Ways & Means Racial Equity Initiative: (7/13) - The House Ways & Means Committee Racial Equity Initiative (REI) co-chairs Reps. Horsford (D-NV), Gomez (D-CA) and Sewell (D-IL) sent a memorandum to House Ways & Means Committee Chair Neal (D-MA), highlighting the ways measures related to transportation, jobs, health care, climate change mitigation, and community investment can purposely counteract generations of discriminatory policy across racial and ethnic lines and expand opportunities for historically marginalized communities.
Restoring Communities Left Behind Act: (7/13) - Sen. Peters (D-MI) introduced the Restoring Communities Left Behind Act (S. 2300), which would direct the Secretary of Housing and Urban Development to establish a grant program to help revitalize certain localities. Specifically, the bill would create a $5 billion program to award competitive grants to eligible local partnerships to carry out neighborhood revitalization support activities to include restoring damaged or vacant properties for affordable housing, providing skills training programs in low-income areas, and improving parks, sidewalks, and other improvements that impact quality of life.
Maternal Health Quality Improvement Act: (7/13) - Rep. Kelly (D-IL) and nine bipartisan cosponsors introduced the Maternal Health Quality Improvement Act (MHQIA) (H.R. 4387), which would amend the Public Health Service Act to improve maternal health, to improve obstetric care in rural areas, and for other purposes. The bill would implement evidence-based best practices and policies within the medical community to improve maternal health outcomes, support health professional training programs focused on biases that may affect quality of maternal care for racial and ethnic groups, and provide funding to establish rural obstetric networks to improve birth outcomes and reduce maternal morbidity in rural areas.
The Washington Times: (6/29) - Senator Dan Sullivan (R-AK) penned an op-ed on his and Sen. Murphy’s (D-CT) bipartisan LINC to Address Social Needs Act, highlighting key facets of the bill and how it will help provide data to help policymakers better target resources to address social needs. In the op-ed, he writes “This bill will help health care organizations and social service organizations better identify needs and partner on interventions to improve health and quality of life, lower long-term health costs, and strengthen communities.”
To view a full list of the legislation we are tracking around social determinants of health, health equity/disparities, and maternal health, click here.
CMS: (7/19) - CMS released the proposed rule for the CY2022 Hospital Outpatient Prospective Payment System (OPPS). The proposed rule, among other policy proposals, solicits input on ways to make reporting of health disparities based on social risk factors and race and ethnicity more comprehensive and actionable. This includes soliciting comments on potential collection of data, and analysis and reporting of quality measure results by a variety of demographic data points, including, but not limited to, race, Medicare/Medicaid dual eligible status, disability status, LGBTQ+, and socioeconomic status.
HHS Office of Minority Health: (7/15) - The CDC and HHS Office of Minority Health developed the Minority Health Social Vulnerability Index (SVI) to enhance existing resources to support the identification of racial and ethnic minority communities at the greatest risk for disproportionate impact and adverse outcomes due to the COVID-19 pandemic. This resource is an extension of the CDC Social Vulnerability Index, which helps emergency response planners and public health officials identify, map, and plan support for communities that will most likely need support before, during, and after a public health emergency.
HHS: (7/15) - HHS awarded nearly $144 million in American Rescue Plan funding to 102 Health Resources and Services Administration (HRSA) Health Center Program look-alikes (LALs) to respond to and mitigate the spread of COVID-19, and enhance health care services and infrastructure in underserved communities and vulnerable populations across the country.
CMS: (7/12) - CMS released an Informational Bulletin that provides states with details on section 209 of the Consolidated Appropriations Act, 2021, regarding Medicaid coverage of certain medical transportation. This section codifies in law the longstanding CMS interpretation that generally requires states to assure necessary transportation for beneficiaries to and from covered services which help to remove transportation barriers for people with Medicaid seeking needed healthcare.
CMS: (7/12) - CMS’ Accountable Health Communities (AHC) Model assesses whether bridging the gap between clinical care and social services can reduce health care utilization and costs for Medicare and Medicaid beneficiaries. In February 2021, CMS hosted its third annual AHC Meeting virtually to convene 28 bridge organizations participating in the AHC Model and key partners, including community service providers, state Medicaid agencies, and advisory board members. The meeting participants collaborated and shared insights to sustain their screening, referral, and navigation strategies to address the health-related social needs of Medicare and Medicaid beneficiaries. This resulted in a brief entitled “Planning for Sustainability and Advancing Health Equity during the Public Health Emergency.”
HHS ONC: (7/9) - HHS Office of the National Coordinator for Health Information Technology (ONC) released version 2 of the United States Core Data for Interoperability (USCDI). For the final version of USCDI Version 2, ONC has included three new data classes and 22 new data elements. Among the 22 new data elements are four SDOH data elements as well as data elements for sexual orientation and gender identity. Standards Bulletin
Department of Veterans Affairs: (7/6) - The VA awarded $418 million in grants to more than 260 non-profit organizations in June, allowing low-income Veteran families around the nation to access services under the Supportive Services for Veteran Families (SSVF) program. SSVF grantees are authorized to use the funds to rapidly re-house Veterans who become homeless or to prevent Veterans from becoming homeless.
SDoH in the News
Advisory Board: (7/21) - Research has been mixed on the efficacy and feasibility of programs aimed at addressing SDOH to improve health outcomes and lower costs. In this blog, the Advisory Board offers four priorities on where to invest limited resources for SDOH interventions when research is limited: synergy with broader organizational goals; feasibility to inflect need over time; ability to allocate internal resources; resources for interventions that already exist.
Healthcare IT News: (7/21) - Healthcare IT News interviewed Dr. Joe Nicholson, chief medical officer at CareAllies, on his perspective on SDOH, analytics, and patient connectivity, and how they can come together to improve patient outcomes. Nicholson commented on how COVID-19 has amplified health disparities, and things such as living in a medical desert or lacking transportation can compound care delays. Health systems have to reach these people and find ways to support them in their communities, and develop new strategies that alter the way care is delivered.
PR Newswire: (7/20) - Healthify and Visiting Nurse Service of New York (VNSNY) announced a partnership to improve the health and wellbeing of patients throughout the New York Metropolitan Area by addressing vital social needs. Through Healthify’s SDOH platform, VNSNY clinicians will be able to screen for social needs, find resources, refer to community-based organizations, and close the loop on referrals.
Intrado Globe Newswire: (7/19) - Clover Health co-hosted an event with faith-based leaders in Atlanta, Georgia focused on identifying health equity barriers and developing creative solutions to increase access to quality services for the Medicare population in the area. Carmalitha Gumbs of Clover, and South Fulton City Councilwoman, said on the event: “To really understand the needs of the Medicare population in Atlanta and determine how to fill those gaps, it’s vital to take a holistic approach to understanding each individual’s health needs and the social health determinants that impact their well-being. People are so much more than the sum of their health conditions. And who is more connected to the community than local church leaders?”
North Carolina DHHS: (7/19) - The North Carolina Department of Health and Human Services (DHHS) announced the state’s five Medicaid prepaid health plans that will join NCCARE360. AmeriHealth Caritas North Carolina Inc., Carolina Complete Health Inc., Healthy Blue of North Carolina Inc., UnitedHealthcare of North Carolina Inc. and WellCare of North Carolina Inc. have joined the NCCARE360 network and will use the platform to coordinate whole-person care, promote health equity and address the social drivers that influence their members’ health.
Bakersfield: (7/16) - Clover Health announced it will enhance its over-the-counter benefit to include groceries moving forward. Members who meet certain criteria, such as having an underlying health condition like cancer or hypertension, would qualify for the benefit and can receive up to $125 in a quarterly stipend to help purchase groceries at major retailers and supermarkets.
Bloomberg Law: (7/16) - Employers are increasingly looking to find ways to identify and address the social needs of their employees. The Leading by Example project, for example, has helped the Pittsburgh Business Group on Health to use data employers have to identify social factors. The project aims to help employers share best practices and develop a plan to work on at least one social determinant of health.
MedCity News: (7/15) - Acknowledging the historic, structural, social and economic challenges that have persisted and inhibited communities of color from achieving prosperous and healthy lives is critical for understanding the impact COVID has had on communities of color. This article highlights how health equity must be viewed as a long-term investment that proactively moves upstream, past the individual and episodic care, into the community. Redefining returns on investment can help to attract the appropriate ecosystem partners to engage with communities through transformative partnerships and investment.
Health Leaders Media: (7/15) - HealthLeaders interviewed Creshelle Nash, MD, MPH, CHIE, medical director for health equity and public programs at Arkansas Blue Cross and Blue Shield, about how she saw health care disparities firsthand during the COVID-19 pandemic, and how this has given the health care system a vehicle to address social determinants and health disparities. She noted the health plan’s involvement in community engagement, and how working side by side with organizations working in this space of health equity and the health of communities can help improve wellbeing,
Kansas Office of the Governor: (7/14) - Kansas Governor Laura Kelly announced her Commission on Racial Equity and Justice has released its second report, making recommendations on how Kansas can improve racial equity around social determinants of health. The report contains 51 recommendations on ways state agencies, the legislature, and local governments can take action to improve racial equity around health care, economics, and education throughout the state.
Inside Health Policy: (7/13) - Maternal health advocates, including groups like ACOG and AAFP, have praised the CMS proposed FY2022 inpatient hospital pay rule, which included a new hospital inpatient quality reporting program measure that will incentivize hospitals to adopt standard labor and delivery practices that reduce maternal mortality. Advocates have also suggested some changes to the proposed Maternal Morbidity Structural Measure, like extending the initial reporting period and having an independent organization focused on developing health care measures and standards review the measure.
Vox: (7/8) - The US has long underinvested in social supports and services, which has contributed to poor health outcomes observed across the country despite increased investment in medical care. Two factors that impact this is that the US does not have many internal models to build on for improving socioeconomic conditions leading to poor health, and lack of resources of funding for new interventions to target social determinants can also be a barrier. This article outlines this issue and various programs working to address this at the state and federal level.
New Research and Reports
Patient Engagement HIT: (7/21) - Researchers from Mount Sinai created a neighborhood-level COVID-19 inequity index for New York City, combining elements of social disadvantage like access to food, employment, community needs, and more to examine how social factors led to unequal infection rates seen at the height of the pandemic. The researchers found a strong link between COVID and the subway - neighborhoods that ranked higher on the COVID-19 inequity index had higher subway ridership even after New York City went into lockdown.
Patient Engagement HIT: (7/20) - An analysis from Robert Wood Johnson Foundation and Urban Institute found that racial health disparities in patient safety incidents persisted for Black patients, who were more likely than White patients to experience adverse patient safety events within the same hospital. Researchers looked at racial disparities across 11 patient safety indicators for inpatients and found that Black patients experienced significantly worse outcomes in six of the 11 indicators.
BMC Public Health: (7/16) - Social determinants such as food insecurity are increasingly being measured during routine health care visits. Understanding the needs and behaviors of individuals or families experiencing food insecurity can help inform the types of resources they need. This study identified modifiable characteristics related to endorsement of two food insecurity screening questions to better understand the resources needed to improve overall outcomes.
Urban Institute: (7/15) - Results from the Denver Supportive Housing Social Impact Bond Initiative (Denver SIB), which was launched in 2016 by the City and County of Denver, show how both people and public budgets benefit when communities invest in housing and services to end homelessness. The Urban Institute tracked implementation of the Denver SIB and evaluated its effects between 2016 and 2020 on how supportive housing affects people’s interactions with the criminal justice system and emergency health services. Approaches like Housing First help to end chronic homelessness, help individuals find stability, and reduce the time and cost associated with the homelessness-jail cycle.
Robert Wood Johnson Foundation: (July 2021) - The Sentinel Communities project follows the experiences of 29 diverse communities and their efforts to promote health and wellbeing. Through this project, the Robert Wood Johnson Foundation looked at how communities were responding to the COVID-19 crisis and examined social conditions impacting COVID outcomes. The latest report offers lessons learned from communities navigating novel challenges related to vaccination rates. Having an operational equity plan appeared to support better and more targeted responses to address COVID-related disparities, and counties and cities that engaged with and involved community members in decision making before the pandemic built trust among residents which helped in COVID response.
Center for Health Care Strategies: (July 2021) - In partnership with the Commonwealth Fund, the Center for Health Care Strategies developed a toolkit to help states use their Medicaid managed care purchasing authority to advance innovations in primary care. The toolkit outlines strategies to support states in defining primary care priorities and advancing core functions, and achieving primary care innovation goals through managed care contractual levers. Modules included in the toolkit will help identify and address social needs and promote health equity, among other areas.
Center for Consumer Engagement in Health Innovation: (July 2021) - This paper examines the barriers that have hindered more widespread collaboration between affordable housing and health care entities and explored opportunities for increasing these partnerships. Following focus group discussions with low-income older adults and health care leaders, authors put forward a three-pronged strategy to advance the role of affordable housing as hubs for addressing health and social needs of low-income older adults.
Annals of Family Medicine: (July 2021) - Federally qualified health centers (FQHCs) are leaders in screening for and addressing patient’s health-related social needs, but variation exists in screening practices. This study looked at social needs screening practices at Michigan FQHCs to characterize screening processes and identify drivers of variation in screening implementation. Findings suggest that FQHCs placed value on the role of Community Health Workers, on sustainable initiatives, and on funding to support continued social needs screening in primary care settings.
Data and Innovation
Government CIO: (7/21) - HHS is placing an increased focus on SDOH data collection and analysis to improve health outcomes through a multi-sector approach. One such program, launched to align with the agency’s open data priorities, is HHS Protect. This data sharing platform was created during the pandemic to facilitate COVID-19 data sharing among stakeholders. HHS is looking at social vulnerabilities to understand where different communities and areas are experiencing challenges with COVID-19. HHS is also working to transform data to make it understandable to guide decision-making.
Bloomberg Law: (7/16) - Provider groups and privacy advocates have said that proposed changes to the HIPAA privacy rules intended to encourage information sharing with social services agencies could pose unacceptable privacy risks. These changes are aimed at encouraging data sharing between health care providers and social services agencies to better address social determinants of health. Those critical of this policy change say that information sharing beyond the reach of HIPAA’s privacy protections should not be accelerated until guardrails are put in place to protect patients and clients from unwanted data exposure or misuse.
Fierce Healthcare: (7/12) - UnitedHealthcare rolled out a program to employers through its Advocate4Me and Advocate4Me Premier products, using predictive analytics to more effectively address members’ social determinants of health. The tool uses de-identified claims data to proactively identify members who may be at greatest risk for social concerns, which arms call center advocates with a curated database of community resources to assist members with their social needs.
National Cancer Institute: (July 2021) - The Healthcare Delivery Research Program of the National Cancer Institute released a new Social Determinants of Health data set. The data set includes select social determinants of health data elements, including race/ethnicity, education, poverty, urban/rural, socioeconomic status, and racial residential segregation indices defined using 2008-2012 American Community Survey data and 2010 definitions of rural urban commuting areas at the census tract level.