Social Determinants Updates


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February 18 to March 4, 2022

Welcome to Aligning for Health's bi-weekly Social Determinants Updates newsletter.

To add news or events to this newsletter, email info@aligningforhealth.org.

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Highlights

Member News

Unite Us: (3/3) - Unite Us announced the launch of its Social Care Payments solution, which is designed to bridge the gap between health care funders and community-based organizations to enable social care funding at scale.

Home Health Care News: (3/3) - Signify Health remained committed to advancing toward a value-based care system in 2021. After the launch of the CMS ACO REACH Model, CEO Kyle Armbrester noted that “ACO REACH is tightly linked to achieving improvements in clinical outcomes by addressing social determinants of health and reducing inequities,” and that “Signify’s in-home evaluations are specifically designed to collect social determinants data and enable the connection of patients to services.”

Unite Us: (3/1) - In this blog that is part of Unite Us’ community-focused blog series called “Keep Us,” the author outlines how Unite Us is focused on building healthier communities by bridging gaps in access to healthy food. Over the past two years, Unite Us has witnessed food assistance organizations across the country pivot creatively in response to the rapidly increasing needs of community members.

Pittsburgh Business Times: (2/28) - UPMC’s Insurance Services division has increasingly invested effort and dollars into programs that go beyond what is traditionally considered health care. The focus has been guided by studies showing the importance of social determinants of health, with UPMC ramping up programs through the Medicaid program and its UPMC Center for Social Impact, which is responsible for programs such as Pathways to Work which helps Medicaid members find meaningful jobs.

Business Wire: (2/24) - Findhelp announced the addition of a new offering to the Epic App Orchard Marketplace called Findhelp Native+. This is the first social care app to integrate with the Epic Community Referral Network (CRN) for Compass Rose and Coordinated Care Management, and will leverage FHIR APIs so that Epic users can search, refer, and close the loop on social care referrals to the findhelp network directly within the patient’s chart.

Health Leaders: (2/24) - Payer responses to HHS health equity proposals reflect a community that is dedicated to advancing health equity, but also knows the limitations and levers that are necessary for better outcomes. This article highlights several comments made by payers to recent HHS requests for information, including the Blue Cross Blue Shield Association comments on the recent Notice of Benefit and Payment Parameters for 2023 recommending the Gravity Project SDOH data collection and standardization as a “multi-industry effort to reduce current barriers to integration of social risk data into clinical decision-making to improve health outcomes."

RISE: (2/15) - Signify Health’s Chief Medical Officer Marc Rothman penned an op-ed on how addressing social determinants of health begins with data. Rothman notes the new CMS Medicare Advantage and Part D proposed rule’s inclusion of having special needs plans capture standardized SDOH data during In-Home Evaluations (IHEs) to identify and track risk factors of beneficiaries. Signify Health has learned that the home is critical to track and collect comprehensive data on social determinants.

Legislative Updates

Data Mapping to Save Mom’s Lives Act: (3/2) - The Senate passed by unanimous consent the Data Mapping to Save Moms’ Lives Act (S. 198), which directs the Federal Communications Commission to include data on certain maternal health outcomes in its broadband health mapping tool. This is an online platform that allows users to visualize, overlay, and analyze broadband and health data at national, state, and county levels.

Choice in Affordable Housing Act: (3/1) - Reps. Cleaver (D-MO) and Katko (R-NY) introduced the Choice in Affordable Housing Act of 2022 (H.R. 6880), which would expand access to affordable housing options for American families by reforming the Section 8 Housing Choice Voucher Program by removing burdensome bureaucratic regulations, incentivizing greater landlord participation, and allowing more vouchers to be used in higher-opportunity neighborhoods.

Senate Finance Committee: (2/23) - Senate Finance Committee Chair Wyden (D-OR) and Sen. Markey (D-MA) sent a letter to Dr. Nelson, Deputy Director of Science and Society, Office of Science and Technology Policy (OSTP), urging the establishment of a national government-wide public-access policy for federally funded research with a focus on equity, sustainability, and strategic technological development.

Housing Our Veterans Act: (2/22) - Rep. Gonzalez (D-TX) introduced the Housing Our Veterans Act (H.R. 6810), which would direct the Comptroller of the United States to report on the availability of affordable housing for veterans who have been participating in any program administered by the Department of Veteran Affairs’ Homeless Program Office.

Member Letter to President Biden: (2/22) - House Natural Resources Committee Chair Grijalva (D-AZ), Rules Committee Chair McGovern (D-MA) and Rep. Leger Fernández (D-NM) sent a letter to President Biden urging him to convene a National White House Conference on Food, Nutrition, Hunger, and Health.

MODERN WIC Act: (2/18) - Reps. Levin (D-MI), Herrera Beutler (R-WA), and Roybal-Allard (D-CA) introduced the More Options to Develop and Enhance Remote Nutrition (MODERN) WIC Act (H.R. 6781), which would ensure the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is more accessible to participants in a pandemic and a twenty-first century economy by permitting video or telephone certifications.

To view a full list of the legislation we are tracking around social determinants of health, health equity/disparities, and maternal health, click here.

Administration Updates

Health Affairs: (3/3) - The CMS Innovation Center (CMMI) announced its new Initiative to Advance Health Equity in this blog post by Dora Hughes, MD, MPH, Chief Medical Officer for CMMI. CMMI’s activities to advance health equity will include developing new models to promote and incentivize equitable care; increasing participation of safety net providers; increasing collection and analysis of equity data; and evaluating health equity impact.

CMS: (3/2) - The Centers for Medicare and Medicaid Services (CMS) released three new resources to share lessons learned from the Accountable Health Communities (AHC) Model:

A Spotlight on Aligning Clinical Partners to a Collective Vision to Address Health-Related Social Needs highlights how model participant Rocky Mountain Health Plans used a multifaceted clinical engagement approach to ensure their clinical partners understood the urgency in addressing health-related social needs (HRSNs). The spotlight includes helpful strategies to build momentum for addressing HRSNs regionally.
Leveraging Community Partnerships: How Advisory Boards Advance Screening, Referral, and Navigation Efforts highlights bridge organizations’ experiences working with advisory boards to address HSRNs, identify service gaps, and conduct quality improvement. The summary includes strategies and key takeaways for recruiting and engaging advisory board members to sustain screening, referral, and navigation activities beyond the AHC Model.
November 2021 Virtual AHC Meeting Summary: Advancing Screening, Referral, and Navigation Beyond the AHC Model highlights key takeaways from the final AHC Meeting, which convened the 28 bridge organizations participating in the AHC Model and key partners. The summary features insights on scaling and sustaining screening, referral, and navigation activities beyond the AHC Model.

NIH: (2/28) - Leaders at the National Institutes for Health (NIH) called for research and policy changes to address oral health inequities that have persisted for many years and pose a major global public health threat. Drawing on findings and recommendations from NIH’s comprehensive report on the nation’s oral health, Oral Health in America: Advances and Challenges, the authors write that equalizing oral health and access to care will require research and policy initiatives that make oral health care more affordable, accessible, and responsive to communities.

CMS: (2/24) - CMS updated the poverty guidelines that are applied to eligibility criteria for Medicaid and the Children’s Health Insurance Program (CHIP). The 2022 guidelines reflect the 4.7 percent price increase between calendar years 2020 and 2021, and for a family or household of four persons living in one of the 48 contiguous states or the District of Columbia, the poverty guideline for 2022 is $27,750.

CMS: (2/24) - CMS announced it has redesigned the Global and Professional Direct Contracting Model (GPDC) Model and is renaming the model the ACO Realizing Equity, Access, and Community Health (REACH) Model. The model is intended to better reflect CMS’ vision of creating a health system that achieves equitable outcomes through high quality, affordable, person-centered care. CMS also officially ended the Geographic Direct Contracting model. CMS released a Request for Applications (RFA) to solicit a new cohort of participants for the ACO REACH Model to begin participation on January 1, 2023. Fact Sheet

HHS ASPE: (2/23) - The HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) released a new report finding that since the implementation of the Affordable Care Act’s (ACA) coverage provisions beginning in 2010, the uninsured rate among Black Americans under age 65 decreased from 20 percent in 2011 (approximately 7.1 million people) to 12 percent in 2019 (approximately 4.4 million people), a decline of 40 percent.

ONC: (2/22) - The HHS Office of the National Coordinator for Health IT (ONC) released a blog highlighting how gaps in health IT use illustrate the inequities that exist in the health care system, which in turn can lead to inadequate patient care, experience, and outcomes. ONC is focused on the concept of “health equity by design,” in which equity is a core design feature of its collective health IT endeavors.

ONC: (2/23) - ONC released a blog post about the agency’s diversity and inclusion efforts both within their health IT work and within the organization itself. The agency’s internal efforts include a focus on minority recruiting and standing up a DEIA committee comprising leadership and staff. Externally, ONC issued grant funding to promote minority education in health informatics and technology, and is implementing its work with an eye toward health equity by design.

CDC: (February 2022) - The Centers for Disease Control and Prevention (CDC) National Center for Health Statistics released a data brief examining children living in households that experienced food insecurity from 2019 through 2020. The brief found that 10.8 percent of children aged 0-17 years lived in households that experienced food insecurity during the past 30 days, and that the percentage was higher for non-Hispanic Black (18.8 percent) than Hispanic (15.7 percent) children. This percentage was also higher for both non-Hispanic Black and Hispanic children compared to non-Hispanic White children (6.5 percent).

SDoH & Health Equity in the News

Patient Engagement HIT: (3/3) - Nemours Children’s Health has successfully built a social determinants of health screening process, although it has not been a linear process. Nemours currently screens for ten social domains with their patients’ parents and have these conversations across the clinical settings. The health system has offered more than 34,000 primary care patients this SDOH screening and has seen 13 percent of all screenings to have identified at least one social need.

AcademyHealth: (3/2) - In this blog, which is part of the AcademyHealth Health Equity Meeting Blog Series, the authors summarize a panel discussion by experts from Medicaid programs, highlighting different state-level efforts to address health equity. As states continue to innovate, their unique solutions can serve as templates for one another in hopes that Medicaid can lead the way in advancing health equity.

Patient Engagement HIT: (3/2) - Nemours Children’s Health received $25 million from the Ginsburg Family Foundation to launch the Ginsburg Institute for Health Equity, which will focus on advancing health equity in pediatric care. The institute will help advance the health system’s initiatives that address pediatric social determinants of health that impact medically underserved children and provide better patient access to improve patient health.

Fierce Healthcare: (2/25) - The Physicians Foundation is accepting applications for its new year-long fellowship program, which is aimed at next-generation physicians passionate about addressing social determinants of health. The program will help physicians gain a deeper understanding of the realm of social drivers and be equipped with frontline perspectives.

Health Affairs: (2/25) - While both patient safety and health equity have been individually and extensively studied, the intersection between patient safety and health equity has not received the same attention. The small body of research on this intersection has revealed race differences in patient safety incidence and reporting. This article proposes three policy changes to existing policies for soliciting data on patient safety to ensure inclusion of race/ethnicity information, which will enable the types of large-scale analyses required to fully understand the extent of this problem, develop necessary interventions, and measure outcomes.

Milbank Memorial Fund: (2/25) - The Biden Administration has made Medicaid expansion a central feature of its Build Back Better health policy platform to reduce disparities. This article explores policy options to make Medicaid more attractive to health care providers, noting that policies like raising Medicaid provider fees and requiring states to benchmark Medicaid prices to Medicare, as well as non-payment approaches to advancing health equity, must also address structural racism.

Insurance Newsnet: (2/24) - AHIP announced its organizational vision for 2022, which includes focusing on improving health equity and helping more Americans obtain and keep their health care coverage. AHIP is prioritizing health equity by ensuring everyone has an equal opportunity to thrive and achieve their best possible health, expanding initiatives to provide health care opportunities to underserved areas and populations, and providing outreach in a culturally competent manner to various ethnic groups.

Patient Engagement HIT: (2/23) - The National Committee for Quality Assurance (NCQA) recently proposed new Healthcare Effectiveness Data and Information Set (HEDIS) measures, which NCQA is seeking public comment on, to understand how effective an organization’s social determinants of health screening is. The two measures under consideration around social needs screening and intervention include: percentage of members who were screened for unmet food, housing and transportation needs; and percentage of members who received a corresponding intervention if needed.

Pharma News Intelligence: (2/18) - Clinical trials can drive progress forward and provide patients with early access to new treatments that lead to better health equity outcomes. As clinical trial diversity is at the core of the health care ecosystem, ensuring people from diverse backgrounds join clinical trials is key to advancing health equity. This article explores this topic in more detail.

Brookings Institution: (2/18) - The pandemic disproportionately impacted Black and Latino communities, leading to racial disparities in cases and deaths. This blog focuses on three key social determinants that are contributing to these disparities: health care access and insurance, environmental exposure, and food access and nutrition. The brief also summarizes the evidence for each determinant’s contribution to health disparities and proposes policy solutions that could help reduce racial inequities by addressing underlying structural issues.

Health Payer Intelligence: (2/17) - Humana partnered with the University of Louisville to help promote health equity and boost health outcomes for underserved communities through the university’s Health Equity Innovation Hub. Humana plans to invest up to $15 million to help fund the hub, and the university will contribute $10 million to the hub’s development.

Spotlight on Maternal Health

Fierce Healthcare: (2/24) - According to new data from the CDC National Center for Health Statistics, maternal mortality increased within the US during the first year of the pandemic, particularly for non-Hispanic Black women and women aged 25 years and older. The country saw a total of 861 maternal deaths reported through 2020, up 14 percent from 2019 and 31 percent from 2018.

Medpage Today: (2/23) - Breastfeeding can provide long-term health benefits for both the mother and child, yet there are significant disparities in who is breastfeeding. Policy solutions that increase the supply of International Board Certified Lactation Consultants who have specialized training in breastfeeding care and support can help close this disparity, and this blog proposes several policy solutions to address this.

Health Leaders: (2/21) - Blue Shield of California launched an initiative that links health care technology and collaboration with community-based organizations to improve services for new mothers and their babies. The health plan’s Maternal Child Health Equity initiative aims to address disproportionate mortality rates among mothers and children, especially in underserved communities.

Data and Innovation

Healthcare IT News: (2/24) - Data sets that train artificial intelligence and machine learning technology may not be representative of the population as a whole, and data that is too narrow in focus can exacerbate racial disparities. In this Healthcare IT News interview, Dr. Art Papier of VisualDx draws from his technical and clinical experiences to explain how to train models on more diverse image and data sets, and why he believes this strategy is key for providing clinicians with reliable and equitable resources that augment decision-making, overcome knowledge gaps, and promote greater health equity and outcomes.

Health Affairs: (February 2022) - The perpetual exclusion and misrepresentation of Asian American experiences in health research is exacerbated by three racialized stereotypes—the model minority, healthy immigrant effect, and perpetual foreigner—that fuel scientific and societal perceptions that Asian Americans do not experience health disparities. This article describes the poor-quality data infrastructure and biases on the part of researchers and public health professionals, and highlights examples from the health disparities literature. The authors provide recommendations on how to implement systems-level change and educational reform to infuse racial equity in future policy and practice for Asian American communities.

New Research and Reports

The Office of Governor Gretchen Whitmer: (3/3) - Michigan Governor Gretchen Whitmer’s Food Security Council released its final report, which includes recommendations to decrease food insecurity in Michigan and highlights the swift action the state has already taken to improve this issue. Recommendations include increasing funding for fresh food through local and regional programs, increasing feedback from residents who use community food programs, and ensuring Medicaid beneficiaries can access medically appropriate food.

Fierce Healthcare: (3/1) - A new study by Better Medicare Alliance found that 99.9 percent of Medicare Advantage plans are offering supplemental benefits in 2022. This includes 69 percent offering a meal benefit to seniors, which advocates have said is critical to addressing social determinants of health.

Patient Engagement HIT: (3/1) - A study in the Journal of the American Board of Family Medicine found that social services addressing physical activity and food insecurity were usually located in areas that did not have those social needs, suggesting that community-based resources that address social determinants of health are not always located in the neighborhoods with the greatest need for them.

Kaiser Family Foundation: (2/24) - A new infographic by Kaiser Family Foundation looks at the persistent disparities in health and health care for Black people, which reflect structural and systematic inequities rooted in racism and discrimination. The COVID-19 pandemic has brought to the forefront and exacerbated underlying health and health care disparities for Black people, and addressing these disparities is key to improving the health and well-being for this population.

Patient Engagement HIT: (2/24) - According to a study published in the Annals of Internal Medicine, COVID-19 patients from more socially vulnerable neighborhoods fared worse health outcomes and required more intensive treatment, yielding concern for neighborhood health disparities among socially vulnerable neighborhoods. When compared to patients in low-vulnerability neighborhoods, those who lived in high-vulnerability ZIP codes had higher rates of organ dysfunction (51.9 percent vs 48.6 percent), organ failure (54.7 percent vs 51.6 percent), in-hospital death (19.4 percent vs 16.7 percent), and more frequently received mechanical ventilation (19.3 percent vs 14.2 percent).

Health Payer Intelligence: (2/23) - An issue brief from Manatt Health outlined how Medicaid programs can use 1115 Medicaid demonstration waivers to expand health equity in several key ways: expanding eligibility and benefits, filling gaps left by the Affordable Care Act, and offering more funding to providers to address their communities’ health equity needs.

Aging and Disability Business Institute: (2/18) - Social Health Access Referral Platforms (SHARPs) are a new type of technology platform that are increasingly being used by health care providers and payers to refer patients to community-based organizations (CBOs) for services to address health-related social needs. This tool from the Aging and Disability Business Institute and Partners in Care Foundation helps Area Agencies on Aging and other CBOs that are considering or already working with SHARPs to have informed discussions with SHARPs and health care entities to utilize these platforms most effectively.

Patient Engagement HIT: (2/18) - A new toolkit from the American Medical Association outlines how organizational commitment, employee education, and patient- and system-level data will be integral to promoting health equity work. The toolkit also outlines how organizations implementing health equity work should focus on creating a shared organizational vision and launching improvement across the care continuum.

Health Affairs: (February 2022) - Medicaid managed care enrollees who are members of racial and ethnic minority groups have historically reported worse care experiences than White enrollees. Using 2014–18 data on 242,274 nonelderly Medicaid managed care enrollees in thirty-seven states, this study examined racial and ethnic disparities in four patient experience metrics. Compared with White enrollees, minority enrollees reported significantly worse care experiences.

Food Research & Action Center: (February 2022) - This report sheds light on the importance of the Supplemental Nutrition Assistance Program (SNAP) for older adults and the positive impacts of the temporary increase in SNAP benefits during COVID-19. This study aimed to better understand the impact that temporary pandemic-related SNAP benefit increases had on the health, nutrition, and overall well-being of older adults as well as their perceptions of SNAP.

Health Affairs: (February 2022) - Theoretical research suggests that racialized felony disenfranchisement—a form of structural racism—is likely to undermine the health of Black people, yet empirical studies on the topic are scant. This study found that living in states with higher levels of racialized disenfranchisement is associated with more depressive symptoms, more functional limitations, more difficulty performing instrumental activities of daily living, and more difficulty performing activities of daily living among Black people.