Aligning for Health Applauds Key SDOH Provisions in FY23 Consolidated Appropriations Act
On December 20, 2022, House and Senate Appropriators released the text of the FY2023 Omnibus Appropriations bill, which includes $1.7 trillion in appropriations for fiscal year 2023 and several key health care extenders and new authorizations. The President signed the bill into law on December 29, 2022.
Aligning for Health was thrilled to see the inclusion of many key social determinants of health policies, funding, and initiatives included in this package. Along with the appropriations bill, the accompanying Joint Explanatory Statement, which cross-references the House Committee on Appropriations Report for the Departments of Labor, Health and Human Services, and Education, and Related Agencies for Fiscal Year 2023 Appropriations, includes additional details related to the appropriated amounts.
CDC’s Social Determinants of Health Accelerator Grants continue to be funded at $8M for FY23.
Section 2201 authorizes the HHS Secretary to award $35M a year in grants, contracts, or cooperative agreements to states or other eligible entities to support the implementation of strategies to address factors related to health outcomes; to establish, maintain or improve technology platforms or networks to support coordination and information sharing; implementation of best practices; and supporting consideration of factors related to health outcomes in preparing for and responding to public health emergencies.
Data Mapping to Save Moms’ Lives Act (12/20) - On December 20, the President signed the Data Mapping to Save Moms' Lives Act (S. 198) into law. The bill will require the Federal Communications Commission to incorporate data on maternal health outcomes into its broadband health maps.
Health Enterprise Zones Act (12/19) - Sen. Padilla (D-CA) introduced the Health Enterprise Zones Act (S. 5293), which would provide for the designation of areas as Health Enterprise Zones to reduce health disparities and improve health outcomes in such areas.
Equity in Agency Planning Act(12/16) - Reps. Maloney (D-NY) and Pressley (D-MA) introduced the Equity in Agency Planning Act of 2022 (H.R. 9610), which would improve the equitable provision of services to underserved communities and individuals. The bill would amend various agency performance planning requirements to ensure that agencies prioritize improving the equitable provision of services in their agency goals. Summary
Federal Government Equity Improvement Act (12/16) - Reps. Maloney (D-NY) and Pressley (D-MA) introduced the Federal Government Equity Improvement Act of 2022 (H.R. 9609), which would establish an Agency Equity Advisory Team and ensure the use of equity. Specifically, the bill would establish several intra-agency and inter-agency working groups to allow agencies, nongovernmental organizations, and stakeholders to share best practices in the collection and use of data for assessing barriers to equity, among other things. Summary
Improving Treatment for Pregnant and Postpartum Women Act(12/15) - Sens. Lujan (D-NM), Whitehouse (D-RI), and Klobuchar (D-MN) introduced the Improving Treatment for Pregnant and Postpartum Women Act 2.0 (S. 5285), which would extend the residential treatment program for pregnant and postpartum women pilot program. Summary
Maternal Health Pandemic Response Act (12/15) - Rep. Underwood (D-IL) introduced the Maternal Health Pandemic Response Act of 2022 (H.R. 9602), which would improve the public health response to addressing maternal mortality and morbidity during the COVID-19 public health emergency. Sens. Warren (D-MA), Booker (D-NJ), Gillibrand (D-NY), and Smith (D-MN) introduced companion legislation in the Senate (S. 5284).
Senate Special Committee on Aging: Setting the Table – Promoting Healthy and Affordable Food for Older Americans Report and Fact Sheets (12/15) - The Senate Special Committee on Aging released a bipartisan report entitled, “Recognizing 50 Years of the Nation’s First Nutrition Program for Older Adults.” The report celebrates the role of the Older Americans Act Nutrition Program in reducing hunger, promoting health, and enhancing the wellbeing and quality of life of older adults. The Committee also released state-by-state fact sheets highlighting the impact of the Older Americans Act Nutrition Program in each Committee member’s state.
To view a full list of the legislation we are tracking around social determinants of health, health equity/disparities, and maternal health, click here. This will be updated soon to reflect bills introduced in the 118th Congress.
ONC: Disparities in Patient Access to Electronic Health Information (1/5) – This blog highlights a recent ONC study that leveraged the latest available data from the Health Information National Trends Survey to identify racial and ethnic disparities in patient portal offers, access, and use. The study also examined the role of providers in facilitating access to EHI by offering patient portals and encouraging their use. Overall, ONC found that in 2019 and 2020, Black and Hispanic individuals were offered and accessed patient portals at significantly lower rates than white individuals. To reap the full benefits of polices aimed at increasing patient access to EHI, it is critical to foster practices that lead to equitable access and use.
Healthy People 2020: Prioritizing Social Determinants of Health (1/5) – Healthy People 2020 released a new infographic on prioritizing social determinants of health. The infographic outlines the five key SDOH domains within the Healthy People 2020 framework and outlines its goals for Health People 2030, which requires that objectives tied to SDOH have 10-year targets.
CMS: HHS Offers States Flexibility to Better Address Medicaid Enrollees’ Needs (1/4) – CMS released guidance
on an opportunity for states to address health-related social needs for people with Medicaid coverage through the use of “in lieu of services and settings” in Medicaid managed care. This option will help states offer alternative benefits that take aim at a range of unmet health-related social needs to help enrollees maintain their coverage and to improve their health outcomes. In addition to outlining this opportunity for states, this letter also establishes the requirements and guardrails states must meet to ensure these innovations are cost effective, medically appropriate, preserve enrollee rights and protections, and fulfill the objectives of the Medicaid program.
HHS: HHS Issues New Strengthened Conscience and Religious Nondiscrimination Proposed Rule (12/29) - HHS issued a Notice of Proposed Rulemaking (NPRM), entitled “Safeguarding the Rights of Conscience as Protected by Federal Statutes,” which proposes to restore the longstanding process for the handling of conscience complaints and provide additional safeguards to protect against conscience and religious discrimination in accessing care.
White House: 2022 in Review (12/29) – The Biden Administration released a 2022 Year in Review blog, outlining 12 achievements made by the Biden Administration in advancing equity and racial justice, addressing hunger and nutrition, launching a rural partners network, and more.
CMS: Summary of Comments in Response to RFI on Access to Coverage ad Care in Medicaid and CHIP (12/20) - CMS released a report based on responses from a request for information (RFI) on access to care and coverage in Medicaid and CHIP. RFI responses were received February 17 through April 18, 2022. The report and corresponding summary
of comments outlined responses noting the importance to screen individuals for social determinants of health and to have flexible payment methods to address medical and nonmedical needs. Additionally, within themes around developing standards for potential access, comments included unifying standards across payer types, incorporating social risk factors and social determinants of health, and travel time.
White House: Biden-Harris Administration Announces Plan to Prevent and End Homelessness (12/19) - The Biden Administration released a federal strategic plan for preventing and ending homelessness in America, which sets a goal of reducing homelessness by 25 percent by 2025. The plan outlines new strategies to prevent homelessness and increase the supply of housing with supportive services, building on the “Housing First” model. The plan also sets the foundation for new initiatives, including one to reduce unsheltered homelessness in a cohort of geographically diverse communities. HHS Press Release
HUD: HUD Releases 2022 Annual Homeless Assessment Report (12/19) – The U.S. Department of Housing and Urban Development (HUD) released its 2022 Annual Homeless Assessment Report (AHAR) Part 1 to Congress, which found that 582,462 people were experiencing homelessness on a single night in January 2022. COVID-19 and its economic impacts could have led to significant increases in homelessness, however investments, partnerships and government agency outreach resulted in only a 0.3 percent increase in the number of people experiencing homelessness from 2020 to 2022.
Reagan-Udall Foundation for the FDA: Reagan-Udall Foundation Launches Real-World Data Initiative to Address Disparities (12/15) - The Reagan-Udall Foundation for the FDA is launching the Real-world Accelerator to Improve the Standard of collection and curation of race and Ethnicity data in health care (RAISE). The initiative, funded by the Food and Drug Administration’s Office of Minority Health and Health Equity (OMHHE), focuses on understanding, aligning, and disseminating best practices to improve real-world reporting, collection, curation, and integration of race and ethnicity data.
SDoH & Health Equity in the News
JAMA Forum: Why a Divided New US Congress Will Not Stall Action on SDOH (1/5) – While a divided Congress in 2023 can mean bad news for advocates working toward larger health reforms, an exception is likely in addressing social determinants of health. This is due to several factors, including: health plans have been expanding their investments in SDOH and exploring how to build SDOH strategies into their business models; state pilot programs are adding momentum to SDOH strategies, including through Medicaid Section 1115 waivers; ongoing action by the Biden Administration to drive federal policies to address SDOH; and bipartisan support of legislation like the Social Determinants Accelerator Act and LINC to Address Social Needs Act.
Managed Healthcare Executive: To Proactively Address SDOH, the ‘Top of Funnel’ is Critical (12/20) – Activate Care recently ran a proactive social care pilot with a managed care organization (MCO) in the Midwest and found that, in order to kick off a successful social care program, the ‘funnel’ is really important. To make a real difference in any community, an MCO, government agency or health care system needs to have a robust list/dataset of its population so the tools, processes and individuals that come after can do the work to identify and engage members with the highest needs.
Managed Healthcare Executive: 4 Reasons Why Unaffordable Medical Bills Are an Important SDOH (12/20) - Medical debt can send people into “a spiral of economic disadvantage,” including a lack of stability and security in personal life, housing and work. A recent study in JAMA Network Open found how unpaid medical bills can lead to a cascade of worsening SDOH and suggests that unaffordable medical bills are themselves an SDOH. This article outlines four reasons why such debt can lead to adverse social outcomes.
Center for Health Care Strategies: Medicaid Managed Care Opportunities to Promote Health Equity in Primary Care (12/19) - The Center for Health Care Strategies, with support from the Commonwealth Fund, has been helping state Medicaid agencies in Louisiana, Mississippi, Oregon, and Washington State advance racial health equity by improving how they purchase primary care from managed care plans. Primary care is often patients’ first (and sometimes, only) contact with the health care system; patients often report they trust the advice of their primary care team. This blog post draws on the experience of these states to suggest promising managed care contracting strategies for advancing health equity.
Business Wire: Envision Healthcare Releases New White Paper Addressing SDOH, Promoting HealthEquity (12/19) – Envision Healthcare released a new white paper detailing how clinicians and health care professionals can work together to improve medical care for all patients. The white paper explores the HHS Office of Disease Prevention and Health Promotion domains around SDOH (health and health care, education, neighborhood and built environment, economic stability, and social and community context) and includes examples of how medical groups like Envision can address SDOH within each domain.
Data & Innovation
Health IT Analytics: Partnership to Expand Health Equity Data to Improve Community Health (1/5) - A collaboration between the University of Notre Dame Lucy Family Institute for Data and Society and Accenture aims to address community health challenges by expanding health equity data and applying analytics approaches to identify care gaps. This new collaboration aims to leverage the Lucy Family Institute for Data and Society's new Health Equity Data Lab to address these issues, with the first venture testing capabilities of artificial intelligence and machine learning in solving health challenges.
MedCity News: Digital Equity as a SDOH – 3 Ways to Empower Patients (12/21) - Technology innovations such as telehealth, virtual second opinions, health trackers, patient portals and remote monitoring devices have been a boon to the health care industry given their ease of use, affordability and proactive nature. However, these innovations have also created further disparities in the health care system. Digital access must be considered as a social determinant of health in order to make health care more accessible and affordable.
Health IT Analytics: Using SDOH Data in Machine Learning ReducedBias
(12/20) – A recent study by Northwestern Medicine researchers found that adding SDOH data into machine learning models led to less bias when predicting outcomes for heart failure patients. The study included performance reviews of five machine-learning models often used to determine the outcomes of hospitalized patients. Prior to adding SDOH data, the best-performing model underdiagnosed several underserved populations, but the addition of SDOH data led to improvements in the fairness of the models.
New Research and Reports
Journal of Public Health Management & Practice: Health Departments’ Role in Addressing SDOH in Collaboration with Multisector Community Partnerships (January 2023) - Multisector community partnerships (MCPs) are key components of the public health strategy for addressing SDOH and promoting health equity. Governmental public health agencies are often members or leaders of MCPs, but few studies have examined the role of health departments in supporting MCPs' SDOH initiatives. This study engaged 42 established MCPs in a rapid retrospective evaluation to better understand how MCPs' SDOH initiatives contribute to community changes that promote healthy living and improved health outcomes.
BMC Public Health: Identifying long-term effects of SARS-CoV-2 and their association with SDOH in a cohort of over one million COVID survivors (12/20) - Despite an abundance of information on the risk factors of SARS-CoV-2, there have been few US-wide studies of long-term effects. This paper analyzed a large medical claims database of US based individuals to identify common long-term effects as well as their associations with various social and medical risk factors. While age and gender are commonly associated with the long-term effects, other social determinants of health such as race, income and education levels have rare or no significant associations.
Boston University School of Medicine: New study finds relatively few hospital NICU’s screen for SDOH (12/15) – A new study by researchers from Boston University looked at the prevalence of standardized SDOH screening and referral among a nationally representative sample of level 2 to 4 neonatal NICUs in the U.S. The study found that only 23 percent of NICUs had implemented this recommended practice. Although many clinical leaders believed that addressing SDOH was feasible, beneficial for infants and families and a priority for neonatal care, less than one quarter of the units reported standardized SDOH screening and referral processes.
Center for Health Care Strategies: Engaging Communities of Color to Promote Health Equity – Five Lessons from New York-Based Health Care Organizations
(December 2022) - Partnering with patients and community members of color to understand needs and preferences is an important step in improving health outcomes and advancing health equity. Health care organizations are at various stages of developing partnership approaches that create meaningful relationships with patients and communities. This brief outlines considerations for health care organizations to improve partnership relationships with patients of color to inform program and policy design.