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.
CareSource: (8/31) - CareSource announced a value-based partnership with Akron Children’s Hospital to improve health outcomes for thousands of children in Northeast Ohio who rely on Medicaid. The agreement focuses on improving outcomes for children and reducing overall cost of care.
GoHealth, Inc: (8/30) - GoHealth, Inc. has partnered with Aunt Bertha to connect GoHealth members with community-based resources to address social determinants of health. The company, which is a leading health insurance marketplace and Medicare-focused digital health company, identifies members’ specific, unmet SDOH-related needs through Member Care Assessments, which TeleCare agents administer during or near Medicare plan enrollment. The partnership with Aunt Bertha will equip these agents with connections to community-based organizations within every state.
Express News: (8/28) - Meals on Wheels San Antonio has partnered with Signify Health to get food delivered faster to clients in need. Signify Health’s platform helps share client records and referrals with other local charities and organizations, and will specifically help Meals on Wheels provide meals to thousands of older adults and disabled residents every weekday. The Alamo Area Community Network (AACN) underwrites the platform, enabling other organizations in the area to leverage the platform to collect data to identify trends and gaps in services.
HCPress: (8/26) - The North Carolina Association of Free & Charitable Clinics (NCAFCC) and Blue Cross and Blue Shield of North Carolina, a health plan of the Blue Cross Blue Shield Association, have awarded nearly $230,000 in grants to five clinics to support initiatives to reduce health disparities by addressing drivers of health such as access to healthy foods, safe housing, transportation, and cultural and language barriers.
3M: (8/25) - 3M Health Information Systems (HIS) has gone all in on clinical risk data and SDOH in order to have a better understanding of what resources are needed most, and where. 3M this year launched the Social Determinants of Health Analytics technology platform that pairs 3M Clinical Risk Group, which identifies medically complex populations, with social risk to understand how it impacts medical complexity and health care utilization.
American Hospital Association - The American Hospital Association’s Seven in Seven podcast series explores ways seven health care organizations are using a digital solution to improve access and delivery of perinatal care. Topics include how an obstetric decision support software can lead to better outcomes and how other platforms can better connect expectant mothers with their doctors and resources, among other topics.
House Committee on Rules: (9/1) - House Rules Committee Chairman James McGovern (D-MA) sent a letter signed by all 25 Committee Chairs in the House to President Biden, urging him to convene a national conference on food, nutrition, health and hunger. The Committee leaders called for further action to address the hunger crisis that has been exacerbated by COVID-19, citing that nearly 40 million Americans lacked the resources to keep food on the table even before the pandemic.
House Committee on Rules: (8/31) - House Rules Committee Chairman James McGovern (D-MA) announced that the Committee will hold a roundtable to examine food as medicine, which will mark the seventh series of committee events highlighting the reality of food insecurity in the US and steps that Congress and the Biden Administration could take to equitably combat it. The roundtable took place on September 1.
Senate Veterans’ Affairs Committee: (8/25) - Senate Veterans’ Affairs Committee Chair Tester (D-MT) announced $1.15 million in federal funding to help end veteran homelessness in Montana. The funding will help transition congregate shelter settings to individual spaces where veterans can reside.
To view a full list of the legislation we are tracking around social determinants of health, health equity/disparities, and maternal health, click here.
Congressional Social Determinants of Health Caucus
The Caucus is also accepting proposals for Congressional briefings that provide insight on social determinants issues, best practices, and policy ideas. To share your ideas for a Caucus briefing, fill out this form.
White House: (9/1) - President Biden is committed to using every tool available in government to produce more affordable housing supply and to make supply available to families in need of affordable, quality housing. As such, the Biden Administration announced a number of steps that will create, preserve, and sell to homeowners and non-profits nearly 100,000 additional affordable homes for homeowners and renters over the next three years, with an emphasis on the lower and middle segments of the market. Specifically, federal agencies will boost the supply of quality, affordable rental units; boost the supply of manufactured housing and two to four unit properties; make more single-family homes available to individuals, families, and non-profit organizations; and work with state and local governments to boost housing supply.
HHS: (8/30) - HHS announced the creation of the Office of Climate Change and Health Equity (OCCHE), which is the first office of its kind at the national level to address climate change and health equity. The Office’s mission is to protect vulnerable communities who disproportionately bear the brunt of pollution and climate-driven disasters, such as drought and wildfires, at the expense of public health.
Department of Veterans Affairs: (8/24) - The U.S. Department of Veterans Affairs (VA) announced the expansion of the Shallow Subsidy initiative and $200 million in grants to 238 nonprofit organizations across the country and territories to provide housing rental assistance to extremely and very low-income veteran households eligible under VA’s Supportive Services for Veteran Families program.
ASPE: (8/24) - HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) released a tool developed to assist states and local communities in braiding, blending, or layering multiple federal funding streams (for example, Head Start and the Child Care and Development Fund) to increase the supply of quality early care and education and increase access to comprehensive early childhood and family support services.
AHRQ: (8/23) - The HHS Agency for Healthcare Research and Quality (AHRQ) issued a report of emergency department visits involving dental conditions. AHRQ found that the highest population rates of dental-related ED visits were among non-Hispanic Black individuals, individuals aged 18–44 years, and those residing in the lowest income communities. In addition, a higher proportion of dental-related than non-dental-related ED visits were expected to be paid by Medicaid (42 vs. 32 percent) or to be self-pay/no charge (26 vs. 12 percent).
SDoH in the News
American Medical Association: (9/2) - The American Medical Association announced a series of CME and educational activities aimed at addressing the root cause of inequities, including racism and other structural determinants of health. This content is aimed at equipping physicians and other learners with core health equity concepts needed to support them as they continue to take action and confront health inequities.
Patient Engagement HIT: (9/1) - Uber Health and the Texas Medicaid program announced it will expand its medical transportation partnership to expand access to care to 4.4 million people, helping to address transportation as a leading social determinant of health. The partnership will allow Medicaid beneficiaries in Texas to order rides to and from medical appointments from the Uber app, which will be considered a covered service by their Medicaid plan.
Urban Institute: (9/1) - This article highlights an event held by Urban Institute on how changes in local and federal policy can improve housing stability, housing affordability, and wealth building opportunities for Black, Indigenous, and Latinx communities. Experts at the event highlighted three key ways to improve housing stability and racial equity for these populations in the long-term: 1) focus on affordable housing to make progress toward racial equity; 2) boost capacity at every level of government to alleviate housing instability among these households; and 3) transform systems to ensure they are creating the most equitable outcomes.
Health Leaders Media: (9/1) - UnitedHealthcare added a data analytics capability to its social determinants of health efforts to better target plan members for social needs support. The payer uses claims information and data analytics to target health plan members who have social determinant needs, and a key metric to measure the impact of such efforts is the percentage of health plan members who accept offers of support. UnitedHealthcare uses a three-pronged approach to addressing social determinants: data analytics; active listening; and employing a social needs questionnaire.
Maximus: (9/1) - In Part Two of its “Best practices and tools for advancing health equity for underserved communities” series, Maximus looks at two specific best practices: procurement and contracting, and stakeholder and community engagement. Agencies and programs can drive equity in a number of ways through the contracting process, such as including standard diversity and inclusion language in government contracts. Additionally, close partnerships with community-serving organizations and community leadership are essential to creating resilient communities, building trust, and addressing inequities in underserved communities.
News Wise: (8/31) - The Fund for Health, a partnership between Penn Medicine and the Wharton Social Impact Initiative, seeks to invest in early-stage businesses striving to strengthen social determinants of health of economically disadvantaged individuals in Philadelphia. The partnership announced its plan to invest $5 million over the next three years to push for measurable progress in socioeconomic factors that impact long-term health, selecting three companies to receive $750,000 for the first round of funding.
Multi-Housing News: (8/27) - The NRP Group and other national developers actively partner with hospitals and other health care providers to address social determinants of health in low-income communities across the country through the Health and Housing Initiative (formerly Housing First). This initiative also aims to promote healthy neighborhoods through affordable housing. In this article, NRP Group Vice President of Development & Head Affordable Housing Aaron Pechota is interviewed about the initiative and how it helps provide affordable housing options.
State of Reform: (8/26) - Leaders across the health care sector in Virginia met for a cross-disciplinary strategy meeting on improving health equity across the Commonwealth. Panelists discussed topics such as payment parity, affordable housing, broadband access, and education at the 2021 Virtual Colloquium Addressing Health Equity in Virginia, hosted by Virginia Commonwealth University. Several keynote speakers highlighted various efforts to address equity across the state, and cited data to stress factors such as how health care delivery models in urban areas may not work for rural communities, for example.
New York State Department of Health: (8/25) - New York State submitted a section 1115 demonstration waiver proposal requesting $17 billion in new Medicaid funding over five years to address health disparities and systemic health care delivery issues that have been highlighted and exacerbated by the COVID-19 pandemic. The proposal includes four goals: building a more resilient, flexible, and integrated delivery system; developing supportive housing and alternatives to institutions for the long-term care population; redesigning and strengthening health and behavioral health system capabilities; and creating statewide digital health and telehealth infrastructure.
Patient Engagement HIT:(8/23) - The National Quality Forum (NQF) will convene industry stakeholders through its Health Equity Advisory Group to discuss how to use clinical quality measures to assess health equity, including logistical challenges involved with such an endeavor. This work will start with an effort to embed equity into clinical quality measures across the care continuum to improve health equity, which has posed a challenge given most quality data is not stratified by demographic.
Pennsylvania Department of Human Services: (8/18) - The Pennsylvania Department of Health and Department of Human Services announced the PA Health Equity Analysis Tool (HEAT), an interactive map that synthesizes Medical Assistance and population health data to show opportunities for intervention to promote better health and health equity. The tool provides state, county, zip code, and census track-level data on a number of population health measures and how they affect local communities and the state as a whole.
New Research and Reports
Milbank Memorial Fund: (9/2) - This study explores the experiences of eight grantee organizations from the Bridging the Gap: Reducing Disparities in Diabetes Care initiative. Authors find that the current payment mechanisms for health care services do not adequately support critical up-front investments in infrastructure to address medical and social needs, nor do they provide sufficient incentives to make addressing social needs a priority.
Patient Engagement HIT: (9/1) - A study by researchers from MIT found that people living in states lifting eviction moratoria face an increased risk for COVID-19 about 12 weeks after the ban has been lifted, which could worsen COVID-related health disparities. The researchers suggested that housing security be considered in public health policy moving forward, as it can have a significant impact on health outcomes and equity.
Patient Engagement HIT: (8/31) - According to data published in JAMA Network Open, while financial incentives have been shown to promote healthy behaviors and increase preventive screenings, they are not as impactful when looking at populations experiencing multiple social determinants of health. This study, which looked at adults over age 50 eligible for colorectal cancer screenings, found that financial incentives resulted in a 33.5 percent colorectal cancer screening rate, while mailed patient outreach resulted in a 30 percent screening rate. When looking at specific patient demographics, financial incentives had less of an impact where there were more low-income patients or patients from racial and ethnic minority groups.
Smart Cities Dive: (8/26) - A report by Urban Institute and The Lab @ DC found that 94 percent of families who participated in DC Flex, DC’s flexible rent subsidy pilot program, were generally satisfied with the program. The report found that 88 percent of participants remained in stable housing and recertified for a second year with the program. The average participant also experienced a nearly 29 percent decrease in the use of homelessness services.
Patient Engagement HIT: (8/26) - Researchers from Yale School of Medicine looked at how structural racism impacts neighborhood composition and affluence, which ultimately impacts patient health and wellness. The study found that older adults living in low-income or otherwise disadvantaged neighborhoods become disabled or lose their independence about two years before those living in more affluent areas.
Alliance of Community Health Plans: (8/19) - The Alliance of Community Health Plans (ACHP) released a white paper outlining a framework for advancing health equity. As advancing health equity requires health care organizations to intervene across multiple, interwoven levels of intervention, including individual, community, and systemic levels, this framework demonstrates how a holistic approach with interventions across all the action loops is necessary to truly improve equity in health care.
Data and Innovation
Patient Engagement HIT: (8/25) - This article highlights the challenges South Texas Physician’s Alliance has faced in understanding how to collect SDOH data, the pain points in social services referrals, and the type of technology and interpersonal partnerships the organization would need. Addressing these three challenges in providing social services referrals is helping to put the Alliance on a path to building out a strong community health network.
Health IT Analytics: (8/20) - While the use of broad data collection can help provide better care for patients and eliminate health disparities, it also has the potential to create other health inequities as health analytics advance to improve outcomes for patients. To ensure patients receive equal and quality care, analytic health technology should engage in broad data collection practices. Focusing on diverse data collection efforts can help improve precision medicine, artificial intelligence, and predictive analytics to eliminate health disparities.