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 - 3M. 3M Social Determinants of Health Analytics helps manage population health through early identification, proactive care management, and more accurate assessment of risk, assign social risk at the member level, and care for members more efficiently and effectively through collaborations with community-based organizations. To learn more, click here.
Patient Engagement HIT: (8/5) - New literature from the American Hospital Association (AHA) shows that health care organizations working to build out community health partnerships to boost health equity and address social determinants need to ensure they are on the same page as those with whom they collaborate. This recommendation came as part of the AHA Health Equity Resource Series, the final of which centers on building community health partnerships as a central tenet of achieving health equity.
Better Medicare Alliance: (8/5) - A new report by the Better Medicare Alliance highlights innovative approaches to address social determinants of health for Medicare Advantage (MA) beneficiaries, while acknowledging barriers that remain in doing so. The report was informed by interviews with experts from organizations representing health plans, providers, non profits, and service and technology vendors, including Unite Us. Report findings revealed that there was a “dramatic increase in plan activity to address social needs” within the MA population, especially around social isolation, transportation, housing and food. MA plans also collect data on beneficiary social risk factors in the absence of consistent data collection guidelines from CMS. Barriers that exist to further SDOH innovations include technology limitations, misaligned incentives, and the disconnect between health care systems and social services. A fact sheet can be found here.
Modern Medicaid Alliance: (7/28) - The U.S. maternal mortality rate is the highest among developed countries. In this video on the Importance of Continuing Medicaid Coverage 365 Days Postpartum, Gloria Eldridge with Health Care Services Corporation (HCSC) explains how the Helping Moms Act will reduce maternal mortality and help improve maternal health outcomes.
CareSource: (7/28) - CareSource launched the CareSource Diversity & Social Impact Investment Fund through a partnership with Elevate Ventures. CareSource will invest $2.5 million in the fund, which will help provide capital for diverse founders and/or those who seek to improve health care outcomes or related social impact.
The Atlanta Voice: (7/27) - New data from the Blue Cross Blue Shield Association’s (BCBSA) Health of America Report shows how Black and Hispanic women are more at risk than White women for severe childbirth complications regardless of age. “The disparities we see in maternal health care are unconscionable and unacceptable, and they require a new system of health caring, not just health care,” Kim Keck, President and CEO, BCBSA said. “These outcomes are likely driven by a number of factors, including maternity care deserts, higher rates of underlying chronic conditions, limited access to health care, continued racial disparities and bias within the system, as well as other barriers which threaten women’s access to necessary and appropriate care before, during and after childbirth.”
Patient Engagement HIT: (7/26) - Sentara Health and its health plan, Optima Health, have used the Unite Us referral platform on the payer and provider ends in partnership with the Virginia Department of Health, Kaiser Permanente, Virginia Mental Health Access Program, and other area leaders to aggregate community organizations for clinicians looking to refer patients to a certain social service. Sentara tries to build out its network around trusted community partners that reach deep into the communities it serves that might not otherwise be reached, and is looking to extend and onboard some church networks into the Unite Us platform moving forward.
Health Care Services Corporation: (7/23) - The US has the highest rate of maternal deaths in the industrialized world, with about 700 women dying every year because of pregnancy-related problems according to the CDC. Health Care Services Corporation (HCSC) was part of a coalition of health plan associations and managed care organizations that joined provider groups and patient advocates to press Congress to extend postpartum coverage in Medicaid as part of the American Rescue Plan Act. HCSC covers nearly one million Medicaid members through its plans, and medical managers and care coordinators help pregnant members access care and find resources such as healthy food and transportation to help them reach full-term pregnancy.
Emergency Child and Nutrition Assistance Act: (8/4) - Reps. Adams (D-NC), Trone (D-MD), Newman (D-IL), and five other cosponsors introduced the Emergency Child and Nutrition Assistance Act (H.R. 4904), which would provide for emergency operational cost reimbursements for child nutrition programs for certain additional months. The bill would extend COVID-19 relief for both the Child and Adult Care Food Program (CACFP) and the school food authorities through the end of the 2021 school year to help cover their operational costs, and would extend operational funds through September 2022.
Protect Moms from Domestic Violence Act: (8/3) - Reps. Moore (D-WI), Underwood (D-IL), Adams (D-NC), and Kuster (D-NH) introduced the Protect Moms from Domestic Violence Act (H.R. 4916), which would study the extent to which individuals are more at risk of maternal mortality or severe maternal morbidity as a result of being a victim of intimate partner violence. The bill would study domestic and sexual violence as a social determinant of health and award grants to programs that improve maternal and child health outcomes of survivors of domestic and sexual violence. Sens. Shaheen (D-NH) and Klobuchar (D-MN) introduced companion legislation in the Senate (S. 2588). Summary
HOME Secure Meals Act: (8/3) - Reps. Vela (D-TX) and Katko (R-NY) introduced the Helping Our Most Elderly (HOME) Secure Meals Act (H.R. 4933), which would amend the Older Americans Act of 1965 to establish a competitive grant program to enable area agencies on aging and local nutrition service providers to purchase, customize, or repair vehicles with hot and cold food storage for delivering meals to older individuals through the Congregate Nutrition Program or the Home-Delivered Nutrition Program. Sens. Manchin (D-WV) and Collins (R-ME) introduced companion legislation in the Senate (S. 2584).
Labor-HHS Appropriations: (7/29) - The House passed by a 219-208 vote the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2022 (H.R.4502). This package included significant funding for addressing social determinants, including matching President Biden’s request of $153 million for the CDC’s Social Determinants of Health program, a portion of which will go towards Social Determinants Accelerator Grants. The package also includes instructions for HHS to continue to implement the Social Determinants Accelerator Council, among other notable provisions.
Revitalizing Downtowns Act: (7/28) - Sens. Stabenow (D-MI) and Peters (D-MI) introduced the Revitalizing Downtowns Act (S. 2511), which would create the Qualified Office Conversion Tax Credit to convert unused office buildings into residential, commercial, and mixed-used properties. The bill would invest in America’s changing downtowns and business districts following the COVID-19 crisis, offer incentives for redevelopment, encourage the expansion of affordable housing options, and more. Reps. Gomez (D-CA), Larson (D-CT), and Kildee (D-MI) introduced companion legislation in the House (H.R. 4759).
EATS Act of 2021: (7/28) - Sens. Gillibrand (D-NY), Van Hollen (D-MD), Smith (D-MN), Leahy (D-VT), Booker (D-NJ), and Sanders (I-VT) introduced the Enhance Access to SNAP (EATS) Act of 2021 (S. 2515), which would amend the Food and Nutrition Act of 2008 to treat attendance at an institution of higher education the same as work for the purpose of determining eligibility to participate in the supplemental nutrition assistance program. Specifically, the bill would expand SNAP benefit eligibility to college students attending two- and four-year universities part-time or more and some graduate students who also meet traditional SNAP income and eligibility requirements to address the hunger crisis affecting such students. One-pager
EDOT During the COVID-19 Emergency Act: (7/28) - Rep. Kelly (D-IL) and five cosponsors introduced the Evaluating Disparities and Outcomes of Telehealth (EDOT) During the COVID-19 Emergency Act of 2021 (H.R.4770), which would study the effects of changes to telehealth under the Medicare and Medicaid programs during the COVID-19 emergency.
Sen. Duckworth: (7/27) - Sens. Duckworth (D-IL), Durbin (D-IL), Booker (D-NJ), Brown (D-OH) and Baldwin (D-WI) along with Reps. Kelly (D-IL), Underwood (D-IL), Pressley (D-MA), Gonzalez (R-OH) and Herrera Beutler (R-WA) led a bipartisan group of 14 Senators and 62 Representatives in a letter to CMS Administrator Brooks-LaSure urging CMS to take immediate steps to implement the new State plan option authority granted by Congress in the American Rescue Plan to provide 12 months of postpartum Medicaid coverage. House Letter
Magnus Healthcare Consulting: (7/27) - The Congressional Social Determinants of Health Caucus was launched in the House on July 21, consisting of 25 bipartisan Members of Congress. The Caucus will serve as a vehicle to drive SDOH policy at the federal level, will act as a discussion hub for challenges and best practices related to social determinants of health, and will seek to inform the future direction of SDOH federal funding.
AgriPulse: (7/27) - In this op-ed. House Rules Committee Chair McGovern (D-MA) and Barbara Petee from the Root Cause Coalition discuss the financial and human costs of hunger, highlight findings from the Coalition’s forthcoming public insights research and call on the Biden administration to hold an overdue White House conference that addresses the hunger crisis in America.
To view a full list of the legislation we are tracking around social determinants of health, health equity/disparities, and maternal health, click here.
Support Legislation Endorsed by Aligning for Health!
Axios: (7/29) - In a recent event held by Axios, Rep. Cheri Bustos (D-IL) called on local communities to help Congress address social determinants of health and tell Congress directly what they need to tackle such problems. On the Social Determinants Accelerator Act (H.R. 2503), of which she co-sponsors, she said “We now are advancing [the Social Determinants Accelerator Act] in the House with the idea being, let's investigate what the social determinants are. Let's let local communities apply for that money and then have the money in that program to actually do something about it once those negative social determinants are discovered through investigation.”
HHS: (8/4) - The White House COVID-19 Health Equity Task Force held its sixth public meeting on July 30 to discuss interim recommendations addressing future pandemic preparedness. Task Force Members discussed and voted favorably on a set of interim recommendations, including to create standardized expectations around data infrastructure and disaggregated data collection, including incentives to collect, report and use disaggregated data; establish and adjust national standards as well as strategically target funding for water, sewage, and air quality to where it’s needed, based on data from reliable equity indicators; explore strategies that meet local and regional staffing needs during pandemic response; and more.
CMS: (7/28) - CMS launched the new Infant Well-Child Visit Learning Collaborative, which is a part of the Maternal and Infant Health Initiative, to support state efforts to increase the number of infants receiving high-quality well-child care. The learning collaborative will offer technical assistance to state Medicaid and Children’s Health Insurance Program (CHIP) agencies and their partners using two strategies: a webinar series (open to all states) and an affinity group for states interested in implementing quality improvement strategies. The webinar series will include presentations from Medicaid and CHIP representatives, as well as other experts in the field on strategies for states to improve the use of well-child visits for infants ages 0 to 15 months.
HHS ONC: (7/27) - The HHS Office of the National Coordinator for Health Information Technology (ONC) issued a blog post highlighting their 2021 ONC Tech Forum, which will be held virtually on September 10 and September 17. On deck for this year’s Tech Forum include combatting health inequities, measuring quality and interoperability, interoperability of public health data and overcoming barriers between care and research. Registration is open.
SDoH in the News
Academy Health: (8/5) - A recent literature review revealed most studies of social needs interventions were poorly designed, inadequately documented, and inconsistently presented. This blog post outlines the state of the research and provides recommendations to improve study design quality through formal guidelines for conducting and evaluating SDOH studies. These guidelines for SDOH evaluations could include focusing on what sample size to use, what outcomes should be reported, and the areas for a proper study design.
Business Wire: (8/4) - Humana released its 2020 Corporate Social Responsibility report, outlining its commitment to advancing health equity and addressing the needs of the community to drive sustainable change. Among highlights in 2020 around these efforts include conducting nearly 6.2 million screenings for health-related social needs and providing $50 million to aid in COVID-19 relief for underserved communities to help them navigate the pandemic through short and long-term programs and partnerships.
mHealth Intelligence: (8/2) - The Wake Forest School of Medicine announced it will launch five projects to examine how telehealth and remote patient monitoring can be used in addressing social determinants of health and access to care. One program, for example, will involve a partnership with Atrium Health to expand the Super Supporter Program using a $919,000 grant over three years. The project will use patient navigators to reach out to vulnerable populations and help them learn how to access and use telehealth.
Patient Engagement HIT: (7/30) - The Patient-Centered Outcomes Research Institute (PCORI) approved $254 million to fund 28 research projects aimed at several health issues, including reducing racial health disparities and decreasing maternal morbidity rates. Four studies will use $33 million to reduce racial disparities in pre- and post-natal care for Black and Latina women. The largest of the four studies will compare different approaches to reduce low birth weight risk among Black infants, and another study will look at whether culturally tailored care improves Black women’s experiences and outcomes.
Health Payer Intelligence: (7/29) - United Healthcare is aiming to address social determinants of health and increase access to care by granting $11.4 million to community-based organizations throughout the United States through its Empowering Health initiative. Grants will support 84 community-based organizations and will be awarded to programs that provide underserved communities with resources such as food, transportation, and mental health services.
Health Affairs: (7/28) - Several recent Health Affairs articles have advocated for social risk adjustment in value-based payment (VBP) systems, outlining how a broader approach toward improving health equity would be a more fruitful approach. This blog post describes the thinking and data analysis in previous Health Affairs reports, and suggests a broader agenda for tackling policy challenges related to social risk and health equity through health-related programs and a variety of social service programs. It proposes a comprehensive strategy for addressing social risk in Medicare’s VBP programs: Measure and report quality for beneficiaries with social risk factors; set high, fair quality standards for all beneficiaries; and reward and support better outcomes for beneficiaries with social risk factors.
Robert Wood Johnson Foundation: (7/28) - A team at Boston University developed the COVID-19 U.S. State Policy (CUSP) database to inform health and social policy decisions that promote health equity and focus on policies that affect vulnerable and historically excluded populations. The database has helped researchers, policymakers, journalists, and others understand how over 200 state policies implemented during the pandemic are impacting health equity. This article looks at lessons learned and where the project will go moving forward.
Health Affairs: (7/27) - Funders are often asked to support projects that convene groups of experts to identify and recommend solutions to societal problems. These groups can include a diverse range of stakeholders whose focus is on intersectionality, the overlapping and interconnected factors that must be considered to arrive at solutions. In this blog post, a workgroup is discussed where some participants were experts in low-value care (LVC), and others were experts in health equity. This post discusses considerations needed when supporting intersectional, multi-stakeholder work and the dynamics of collaborating with another funder on awarding grants and managing the grantee relationship.
Fierce Healthcare: (7/26) - Anthem announced it will invest nearly $90 million in affordable housing in Indiana, which will fund 1,139 affordable apartment units, townhomes, and single-family homes across 11 communities in the state. The insurer has thus far committed $410 million across 45 states, DC, Puerto Rico and Guam to affordable housing.
Penn Medicine News: (7/26) - Penn Medicine established a new center to directly connect vulnerable patients to surgical care, known as the Center for Surgical Health. This center will provide a new access point to sustainable, high-value surgical care for patients who typically rely on the emergency room for treatment. The center also has a research, policy and education arm, with courses being implemented into the curriculum at the Perelman School of Medicine centered on surgical equity such as the introduction of social determinants of surgical health.
HealthIT Answers: (7/26) - In this article, HSBlox chief revenue officer John Schwartz outlines the incentives, barriers and levers for scale in social determinants of health. Providers, payers and community programs share two major incentives to succeed at truly mastering SDOH: achieving desired outcomes and generating sustained financial impact. Schwartz proposes three approaches to building levers to scale SDOH: use AI and ML to target the most vulnerable individuals; create certain elements at the enterprise level as capabilities required for critical inputs into SDOH to meet partners where they are technically; and integrate SDOH payments into the scale used for the rest of an enterprise.
Health Affairs: (7/23) - The barriers that have been identified to ensure an equitable uptake of COVID vaccines are varied and deep, and include issues such as obstacles to accessing care, lack of vaccine confidence, decades of systemic racism, and more. Overcoming these barriers was essential for CVS Health as a member of the Federal Retail Pharmacy Program. This blog outlines how CVS Health approached the critical issue of targeting and vaccinating the most high-risk sub-populations within Phase 1B of the vaccine rollout, which involved creating algorithms to ensure equitable distribution and targeted initiatives to certain populations.
Fierce Healthcare: (7/23) - SCAN Group is launching a new medical group called Healthcare in Action to provide specialized care to homeless patients. The group will serve SCAN’s members by providing “street medicine” to seniors, one of the fastest growing homeless populations. Healthcare in Action will begin offering services in January in several communities located in Southern California.
Milbank Memorial Fund: (7/23) - During the pandemic, individuals with intellectual and developmental disabilities have experienced higher COVID-19 mortality rates and a deterioration in service access and quality. Many Americans with disabilities endure serious health disparities and unmet service needs, in addition to severe financial distress. This op-ed recommends several federal and state-level policy changes to address health disparities in the disability community, including accounting for functional impairment for Medicare and Medicaid payment rates, encouraging medical schools and residency programs to address issues related to disability, and more.
Health Affairs: (7/20) - The pandemic has highlighted the complex interdependence of ecological, animal, and human health that is typically overlooked in mainstream conversations around food system practices. Systematically addressing the interconnected health risks of food systems requires these connections and failures of the current system to be acknowledged. This article looks to connect the dots between health crises and food systems transformation, and the policy levers needed to do so.
New Research and Reports
Kaiser Family Foundation: (8/5) - While federal Medicaid rules prohibit expenditures for most non-medical services, state Medicaid programs have been developing strategies to identify and address enrollee social needs both within and outside of managed care. This issue brief by Kaiser Family Foundation describes options and federal Medicaid authorities states may use to address enrollees' social determinants of health and provides state examples, including initiatives launched in response to the COVID-19 pandemic. The focus of the brief is on state-driven Medicaid efforts to address social determinants for nonelderly enrollees who do not meet functional status or health need criteria for home and community-based services programs.
Business Wire: (8/4) - Health Net, one of the longest serving Medi-Cal partners in California, published a report outlining the company’s comprehensive approach to addressing health disparities, particularly among communities of color. The report focused on California’s growing Medi-Cal enrollment and identified the following recommendations and strategies to address health disparities: 1) Programmatic-Focused - understand and develop tailored solutions targeted to specific patient populations and consider each social determinant of health as programs are developed; 2) Investment-Centered - invest to support organizations who serve the communities where they operate and work hand-in-hand to identify and fund gaps in the safety net; and 3) Education-Focused - develop culturally competent training at every level.
Health Affairs: (7/29) - New or expanded public transportation options could improve physical and mental health and health equity by increasing access to medical care, healthy food, vital services, employment, and social connections. This policy brief examines the relationship between urban public transportation and health and health equity. It primarily focuses on the potential health and health equity impacts of urban public mass transportation on individuals and communities, and highlights policy and practice interventions that may help states and municipalities better align urban public transportation and public health goals.
American Heart Association: (7/28) - The American Heart Association CEO Roundtable released a report that provides a roadmap to help employers strive for health equity, called Driving Health Equity in the Workplace. The report details several approaches organizations can take to remove institutional roadblocks that have resulted in inequities based on race, ethnicity, gender, sexual orientation, age, ability, and other factors. It also offers a set of guiding principles and organizational strategies to promote equity through policies, practices and workplace culture.
U.S. News & World Report: (7/27) - A new analysis by U.S. News & World Report revealed that racial and ethnic minorities are underrepresented among patients who access many common services at about four out of five U.S. hospitals. Patients who had certain procedures done, such as joint replacement and cancer surgery, were disproportionately white, and only 29 percent of hospitals treated a proportion of Black patients that was comparable to or higher than the proportion of Black residents in the community. Additionally, only 18 percent and five percent of hospitals met this bar for Hispanic and Asian/Pacific Islander patients, respectively.
JAMA Internal Medicine: (7/26) - This study focused on whether Medicare eligibility is associated with reductions in racial and ethnic disparities in access to health care. Findings suggest that eligibility for Medicare at age 65 was associated with reductions in racial and ethnic disparities in insurance coverage, access to care, and self-reported health across the US, but not in mortality. As such, the study findings suggest that expanding eligibility for Medicare may help to reduce racial and ethnic disparities and advance health equity by closing gaps in insurance coverage and access to care.
Partners for Rural Transformation: (7/22) - The Partners for Rural Transformation developed this proposal in line with an inclusive approach to revitalizing communities, which involves changing income limits for eligibility to participate in housing and community development programs to include a national non-metro floor. The proposal would allow low-income individuals in the poorest places to access already-existing public investment, which could help jumpstart a cycle of increased housing and community development, create more jobs to rebuild the rural economy, and play a pivotal role in moving millions of people out of poverty.
Center for Health Care Strategies: (July 2021) - Local health departments (LHDs) in rural communities are often the crossroads for key services in resource-deprived settings and are frequently the first or only providers to offer physical or behavioral health services, resources to expecting or new parents, and health education and outreach programs. LHDs have also been ideal candidates to work with stakeholders in addressing housing needs in rural communities. This brief serves as a guide to LHDs in using Medicaid managed care levers to address homelessness and housing insecurity in rural communities, which can help states improve health outcomes for Medicaid enrollees.
Journal of the American Board of Family Medicine: (July 2021) - This study looked at the relationship among adult primary care patients with multiple chronic conditions and the impact of social determinants of health on overall outcomes. Of those surveyed, 29 percent reported the prevalence of at least one social determinant, including food (13 percent), housing (three percent), or financial (25 percent) factors. The prevalence of SDOH among primary care patients with chronic conditions was associated with poorer functional capacity, independent of other social and demographic factors, highlighting the need to explore the role of screening and intervention by primary care providers around SDOH.
PhRMA: (July 2021) - According to the new Medicines in Development 2021 Report on health equity from PhRMA, there are over 800 medicines in development for diseases that disproportionately affect racial and ethnic communities. This report explores the medicines in development targeting the diseases and conditions which affect racial and ethnic communities at a higher rate than the average population and are associated with worse COVID-19 outcomes.
Data and Innovation
mHealth Times: (8/4) - Socially Determined announced a set of enhancements to its SocialScape platform, which provides Social Risk Intelligence to enable payers, providers, government organizations, and more to understand social risk factors and where high concentrations of social risk exist, and how they impact health outcomes. The enhancements will accelerate the speed with which organizations can extract insights and value from the platform by adding more robust and frequently updated datasets, visualizations that provide a more holistic view of the risk facing individuals, faster data integration, and more.
Health IT Analytics: (7/28) - Researchers from the New York University’s School of Global Public Health and Tandon School of Engineering found that machine learning can accurately predict cardiovascular disease and guide physicians to select treatment options. Incorporating social determinants of health into machine learning can not only improve machine learning predictive models, it can help to better treat this disease in more diverse populations. However, most models do not usually include the full list of community-level or environmental factors that are critical to determine cardiovascular disease risk.
JAMA Network: (7/27) - The Agency for Healthcare Research and Quality (AHRQ) recently created an online visualization tool providing county-level information about people’s internet access using data from its social determinants of health database. The tool helps show how internet access is an essential tool for health care, as it helps patients to obtain home-based telemedicine and is increasingly important for basic health care access like scheduling appointments, getting test results, and accessing medical records.
Modern Healthcare: (7/26) - Insurers are continuing to invest in predictive analytics to identify social determinants of health needs among commercial enrollees. In response to the 83 percent of large employers that identified social determinants as essential to their strategy to address employee health over the next three years, health plans are looking to technology to inform new benefit structures. For example, UnitedHealth Group launched a predictive analytics program to address social support needs for enrollees of some employer-sponsored benefit plans, which uses de-identified claims data, Census information, member assessments, and more to generate a personalized health risk score for each member. Members utilizing the plan’s call center can then be referred to local, state, and national social services organizations to bridge gaps in access to care.