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.
American Hospital Association:(10/13) - In the latest episode of the American Hospital Association Advancing Health podcast, Alpa Shah, MD, director of the Perinatal Mental Health Clinic at Marshfield Clinic Health System and Nirmaljit Dhami, MD, medical director of inpatient perinatal psychiatry at El Camino Health, discuss the need for patient-centric care and connecting patients with support services to manage their mental health.
WIS News 10: (10/13) - Alliance for Better Health and Catalyst @ Health 2.0 awarded Cogitativo the grand prize in its Rapid Response Open Call, which is for tech innovators and looked for innovative solutions to assist medical and social care providers in optimizing vaccine administration to vulnerable and underserved communities. Cogitativo’s technology combines SDOH data, clinical data, and peer-reviewed research to effectively and efficiently identify populations at greatest risk of experiencing negative health outcomes, down to the zip code level.
Dayton Business Journal: (10/13) - CareSource has over two million members in five states, serving a diverse demographic, and has spent years developing initiatives to reduce and eliminate health disparities within its communities. This article discusses how diversity, equity and inclusion shapes CareSource’s mission.
BlueCross BlueShield: (10/5) - Blue Cross Blue Shield of Massachusetts (BCBSMA), a health plan of Blue Cross Blue Shield Association, published data in a first-of-its-kind health equity report, finding racial disparities in the quality of care on nearly 48 measures among more than 1.3 million members. BCBSMA plans to update this report every year to understand where the gaps are in order to address and close them for members.
Digital Health Forward: (10/3) - In this episode of the Digital Health Forward podcast, Dan Brillman, co-founder and CEO of Unite Us, discusses the future of whole-person health and how Unite Us is helping to lead the care transformation movement towards whole-person care. Brillman also talks about why social determinants of health matter and the measure impact Unite Us’ platform has had on health outcomes.
House Ways & Means Committee: (10/14) - The House Ways & Means Committee Democratic staff released a new report examining the misuse of race in clinical algorithms and exploring potential strategies to address inequities in clinical decision support tools (CDSTs) that lead to disparities in patient outcomes. The report also includes analyses of stakeholders’ responses to a 2020 RFI soliciting input and recommendations on the matter.
To view a full list of the legislation we are tracking around social determinants of health, health equity/disparities, and maternal health, click here.
Stakeholders Submit Comments to Congressional SDOH Caucus RFI
HHS: (10/12) - The COVID-19 Health Equity Task Force held its seventh public meeting to vote on a final slate of recommendations for mitigating health inequities caused or exacerbated by COVID-19. The Task Force discussed and voted favorably on suggested actions for the Biden-Harris Administration to prioritize and propose outcomes to set the vision for the country’s goals. The Biden-Harris Administration has already taken steps to address approximately 57 percent of the over 300 recommendations put forward by the Task Force. The final meeting will be October 28 to discuss the Task Force’s final report before it is sent to the White House.
GAO: (10/12) - The Government Accountability Office (GAO) published a blog to look at its work on federal programs to address food insecurity in the US. The blog looks at a new program that was created during the pandemic called the Farmers to Families Food Box Program, as well as existing programs and how the pandemic has impacted their operations and demand.
CMS: (10/8) - CMS released the final annual report for the State Innovation Models initiative. Model test states used SIM Model Test funds to test innovative health care models and transform their health care systems to incentivize better care and lower costs. Overall, states increased the use of value-based payment models, particularly in Medicaid, and invested in primary care transformation and behavioral health integration, which increased provider capacity to provide quality care. States that addressed health-related social needs at the community and patient-level also created connections between clinical and community resources. Many states sustained programs after the SIM award.
HHS: (10/7) - HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) issued a request for comments on the draft HHS Strategic Plan for Fiscal Year (FY) 2022-2026. The document articulates how the Department will achieve its mission through five strategic goals including: 1) Protect and Strengthen Equitable Access to High Quality and Affordable Health Care; 2) Safeguard and Improve National and Global Health Conditions and Outcomes; 3) Strengthen Social Well-being, Equity, and Economic Resilience; 4) Restore Trust and Accelerate Advancements in Science and Research for All; and 5) Advance Strategic Management to Build Trust, Transparency, and Accountability. Comments are due by November 7.
CMS: (10/6) - CMS Office of Minority Health released a new data highlight on using Z Codes for SDOH among the Medicare fee-for-service population. The data highlight found that among the 33.1 million continuously enrolled Medicare beneficiaries in this population in 2019, 1.59 percent had claims with Z codes, an increase from 1.31 percent in 2016. Other findings include that the five most utilized Z codes were those for homelessness, disappearance and death of family members, problems related to living alone, problems related to living in a residential institution, and problems in relationships with a spouse or partner.
SDoH & Health Equity in the News
Healthcare Innovation: (10/13) - Several pediatric health systems are working to screen families for social needs that impact their health, utilizing strategies ranging from standardizing screening processes to moving from screening to closing the loop with community-based organizations. Nemours Children’s Health System has been looking at how to implement a screening tool to look at social factors across its enterprise, as well as how referrals and interventions would be handled. Cincinnati Children’s Hospital Division of General & Community Pediatrics is looking at how screening can be connected to action to link approaches to screening with potential intervention strategies, including through building its health equity network.
Health Evolution: (10/13) - The link between the environment and its impact on health has become more apparent in recent years, with experts raising awareness on how climate change can impact patient outcomes. This article looks at ways executives in the health care sector can plan for climate change and health equity and the importance of partnerships in advancing health equity.
Fierce Healthcare: (10/11) - According to the Institute for Healthcare Improvement (IHI), health equity is becoming an increasing priority for providers, and insurers can play a role in supporting such efforts. As health systems often face barriers in advancing health equity, health plans can play a critical role in facilitating data exchange and setting clear standards for measuring the efficacy of health equity initiatives.
AIS Health:(10/7) - State Medicaid agencies have begun to place an increased emphasis on health equity and SDOH, and MCOs have to consider this factor when competing for new Medicaid contracts. During a presentation at the AHIP 2021 National Conference on Medicare, Medicaid & Dual Eligibles, Medicare managed care experts discussed trends in Medicaid requests for proposals and ways MCOs can respond accordingly.
Fierce Healthcare: (10/7) - Optum and SSM Health have partnered to address affordability and accessibility of health care, and will also jointly invest in community health initiatives that advance health equity. These investments, done with Optum parent company UnitedHealth Group, will focus on addressing health equity gaps and other priorities in SSM’s key Midwest communities.
PR Newswire: (10/7) - OCHIN was selected to lead the data and research component of the National Institutes of Health AIM-AHEAD program, a new artificial intelligence and machine learning (AI/ML) consortium to advance health equity and research diversity. This initiative brings together experts in community engagement, AI/ML, health equity research, data science training, and data infrastructure to close two significant gaps in the AI/ML field: a lack of diversity in its researchers, and lack of diversity in data used to train AI/ML models for industry use.
Health Affairs: (10/6) - The recent CMS FY2022 Hospital Inpatient Prospective Payment System Final Rule did not include a quality measure specific to malnutrition in the Hospital Inpatient Quality Reporting (IQR) Program, which the authors of this article cite as a missed opportunity to address poor nutrition. The authors state that this is a disappointing omission given the availability of a new National Quality Forum (NQF)-endorsed measure for malnutrition in the hospital, and present several examples of how adopting this measure would be a way for CMS to demonstrate it is tackling health equity.
Health Affairs: (10/6) - While the Supplemental Nutrition Assistance Program (SNAP) has been successful in addressing food insecurity in the US, it is underused by those who are eligible. This is due to a number of factors, including lack of knowledge about the program and confusion around eligibility and documentation requirements. This article describes how the health care sector can take an active role in closing the gap between SNAP eligibility and enrollment.
Center on Budget & Policy Priorities: (10/4) - Closing the Medicaid coverage gap as part of the economic recovery legislation currently being considered in Congress would help make health coverage more affordable to over two million low-income individuals who lack access, particularly for people in rural communities and people of color. This article describes how closing the coverage gap would provide a pathway to affordable coverage, greater availability of services in rural areas in non-expansion states, and advance health equity in rural communities of color.
New Research and Reports
Health Payer Intelligence: (10/11) - The Bipartisan Policy Center (BPC) released a report calling for HHS to expand the list of SDOH that can be covered by public payers and to hold public payers accountable for covering preventive services that can help address social determinants. BPC recommended a multifaceted approach, recognizing the need to better bridge the divide between the siloed worlds of health and health care, consisting of policies that aim to better integrate, coordinate, and improve the performance and outcomes of both non-medical and preventive services in Medicaid.
Patient Engagement HIT: (10/8) - According to a report in JAMA Network Open, clinician advocates could be crucial in leveraging landlords into accommodating housing quality issues. The study showed that an EHR-hosted letter template from a pediatric clinician was effective at motivating landlords to address housing quality issues that could serve as key social determinants of health.
Center for American Progress: (10/7) - To meaningfully improve the health of Americans, new policies must target all of the drivers of health. This report explains the reasons for US health disadvantage and suggests policy solutions, along with explaining that health outcomes in the US are shaped less by health care and more by social determinants of health.
BMJ Open: (10/6) - This study aimed to characterize oncologists’ perceptions of the impact of social determinants on their patients and their opinions on how these effects could be remediated. Of the 165 physicians surveyed, 93 percent agreed that SDOH had a significant impact on their patients’ health outcomes, and identified financial security/lack of insurance and access to transportation as the greatest barriers for patients. Physicians reported being constrained in their time to assist patients with such social needs.
Health Payer Intelligence: (10/6) - According to a report from Health Affairs, policymakers may be able to improve maternal health and health care coverage around the time of pregnancy through Medicaid expansion. The study found that Medicaid expansion was associated with a 16 percent decline in self-reported pre-pregnancy depression but was not associated with postpartum depressive symptoms or well-being.
Patient Engagement HIT: (10/5) - Research published in JAMA Network Open found that institutionally racist policies like redlining continue to manifest themselves in poor health outcomes and maternal health disparities among women of color. The study found that poor outcomes happening today, including high instances of preterm birth and severe maternal depression, were largely concentrated in areas that in the 1940s had been deemed “hazardous” for homeowner’s loans by the HOLC.
Milbank Memorial Fund: (10/5) - This study aimed to demonstrate the value of expanding from a social model of health to a sociolegal model of health and empowering health actors to use the law more strategically in the pursuit of health equity. The authors find that addressing inequities produced by governing policies and institutions can lead to increased collaboration among legal and health scholars, practitioners, and advocates. Health justice partnerships, which embed legal help into health care settings, are an example of a sociolegal model of health that demonstrates how the law can be used as a tool to reduce social and health inequities.
Health Affairs: (October 2021) - One in five pregnant or postpartum people has a diagnosed mood or anxiety disorder, and if left untreated could lead to poor outcomes for the mother and child. This brief looks at policy opportunities designed to overcome the barriers and support overall sexual and reproductive health to address this issue, including expanding Medicaid coverage through 12 months postpartum and enacting social and economic policies that support families.
Center for Health Care Strategies: (October 2021) - Evidence-based home visiting programs can help reduce racial and ethnic health disparities by providing mothers with screenings, case management, family support, and referrals that address a family’s physical, mental and health-related social needs. This brief looks at strategies used by state Medicaid and health agencies in New York, Minnesota, and Vermont to improve equitable health and well-being outcomes through their home visiting programs.
Health Affairs: (October 2021) - As perinatal mental health disorders are often contributors to adverse maternal outcomes, this study aimed to estimate hospitalization cost, length-of-stay and severe maternal morbidity associated with perinatal mental health disorders. Among several findings, the study found that people with mental health disorders had $458 higher costs per delivery hospitalization and 50 percent higher rates of severe maternal morbidity compared to those without mental health disorders.
Data and Innovation
EHR Intelligence: (10/7) - According to a study published in JAMIA, machine learning offers significant potential to extract social determinants of health data from EHR clinical notes, which could aid in the development of clinical decision support systems. Researchers observed two major steps associated with SDOH extraction systems: gathering SDOH-related keywords to create lexicons for each SDOH category, and developing rule-based or supervised systems to locate clinical notes associated with SDOH categories or extract SDOH concepts.
EHR Intelligence: (10/6) - Lawrence General Hospital in Massachusetts leveraged a MEDITECH EHR integration to boost SDOH data analytics and track health outcomes. The hospital, which had success in working with MEDITECH to develop a dashboard for the EHR using patient experience metrics, partnered with the EHR vendor to implement a health equity dashboard, which aggregates SDOH data collected through patient registration and integrates it in a customizable digital format for clinical data analytics.