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.
BlueCross BlueShield of North Carolina: (9/15) - UNC Health and UNC-Chapel Hill researchers collaborated with Blue Cross NC, a health plan of BlueCross Blue Shield Association (BCBSA), to invest $3.2 million in a clinical study to establish sustainable best practices for helping individuals access nutritional food options. The clinical trial, which is targeted at at-risk members who have hypertension, will measure how to best help people who are food insecure achieve better health through nutrition.
Arkansas BlueCross BlueShield: (9/14) - The Blue Cross Blue Shield Association (BCBSA) recently released its 2020-2021 Community Investment Report: Leading Through a Public Health Crisis, which highlights the “all-in” approach from the 35 BCBSA health plans to support response and recovery efforts for COVID. This included an investment of over $11.5 billion, which included efforts to support vulnerable populations and communities of color that were disproportionately impacted by the virus. For example, BCBSA health plans collectively contributed over $315 million to community-based nonprofits to address social issues exacerbated by COVID.
American Hospital Association: (9/9) - According to a recent analysis released by the American Hospital Association that looked at tax-exempt hospitals, non-profit hospitals provided $105 billion in community benefits in 2018, representing 13.5 percent of total expenses for such hospitals in that year. Benefits included financial assistance, Medicaid and other means-tested government program underpayments, community health improvement services, research, health professional education, subsidized services, and other community benefits and building activities.
CareSource: (9/9) - HHS Secretary Becerra invited CareSource to participate in the Medicaid Reentry Stakeholder Group to provide advice and consultation to the Secretary on innovative strategies to help individuals who are inmates of public institutions, and otherwise eligible for Medicaid, ensure continuity of coverage and seamless transitions back to the community. CareSource has been a leader in this space over the last five years, with CareSource’s reentry programs helping to improve health outcomes for incarcerated individuals, reduce recidivism and improve state and local partnerships to deliver safety net benefits while also addressing social determinants of health. Additional coverage on these programs was featured in an article by Patient Engagement HIT.
American Hospital Association: (9/7) - In a recent episode of the InOn Health podcast, Joy Lewis, American Hospital Association's (AHA) senior vice president of health equity strategies and executive director of the Institute for Diversity and Health Equity, discussed the role that hospitals and health systems play in striving for health equity. Lewis also discussed opportunities to eliminate health disparities and AHA’s vision to support its members in these efforts.
Next Pittsburgh: (9/1) - To address affordable housing in Pittsburgh, UPMC Health Plan is investing an initial $7.9 million in capital in an Affordable Housing Loan Fund to create or preserve 330 affordable housing units and enable such projects to move ahead at a quicker pace. UPMC Health Plan spearheaded the development of the fund as part of its participation in Accelerating Investments for Healthy Communities, an initiative funded by the Robert Wood Johnson Foundation for the Center for Community Investment.
Voice of Business Podcast: (9/1) - On this episode of the Voice of Business podcast by the Chamber of Commerce Hawaii, Community Engagement Manager at Unite Us Carol Hayashida discusses how coordinated care network Unite Hawaii is working to address social needs and improve health across communities in the state. Another coordinated care network of Unite Us, Unite Virginia, was also featured in a recent episode of the Rural Health Voice podcast, which can be found here.
Device Access for Every American Act: (9/14) - Rep. McEachin (D-VA) introduced the Device Access for Every American Act (H.R. 5257), which would direct the Federal Communications Commission to establish a program through which eligible individuals may obtain up to $400 in vouchers for the purchase of connected devices such as laptops, tablets, and desktop computers. The bill would ensure every American can participate and thrive in the digital economy, regardless of income or zip code. Sen. Warnock (D-GA) introduced companion legislation in the Senate (S. 2729). One-pager
House Committee on Rules: (9/13) - House Rules Committee Chairman James McGovern (D-MA) announced that the committee will hold a roundtable examining the important role schools play in ending hunger on September 15. This event marked the ninth in a series of events highlighting the reality of food insecurity in America and examining steps Congress and the Administration can take to equitably combat it.
Affordable Housing Equity Act: (9/10) - Reps. Gomez (D-CA) and DelBene (D-WA) introduced the Affordable Housing Equity Act (H.R. 5219), which would designate projects serving extremely low-income households for purposes of allocating the State housing credit ceiling and determining an increased amount of low-income housing tax credit. Specifically, the bill would enhance the Low-Income Housing Tax Credit (LIHTC) to directly incentivize the development of affordable housing for extremely low income (ELI) households.
Public Transportation Expansion Act: (9/10) - Reps. Johnson (D-GA), Williams (D-GA), Bourdeaux (D-GA), and Garcia (D-IL) introduced the Public Transportation Expansion Act (H.R. 5228), which would provide for competitive grants to support access to affordable housing and the enhancement of mobility for residents in disadvantaged communities or neighborhoods. Specifically, the bill would create a Federal grant program to fund public transportation expansion to serve low-income communities and connect affordable housing with transit networks. Sens. Ossoff (D-GA), Warnock (D-GA), Cortez Masto (D-NV), Warren (D-MA), Smith (D-MN), Van Hollen (D-MD), and Cardin (D-MD) introduced companion legislation in the Senate (S. 2726).
Closing the College Hunger Gap Act: (9/10) - Rep. Hayes (D-CT) introduced legislation (H.R. 5222) that would address food and housing insecurity on college campuses. Specifically, this bill would direct the Secretary of Education to notify college students of their eligibility for SNAP using FAFSA information.
House Energy & Commerce Committee: (9/9) - The House Energy & Commerce Committee held its markup of its portion of the Build Back Better Act. Notably, the text included several investments from the Black Maternal Health Momnibus Act to address maternal mortality, erase racial and ethnic maternal health disparities, and advance birth equity in the US. Several provisions were included and advanced, such as $175 million to award grants to address social determinants of maternal health for pregnant and postpartum individuals and $100 million for maternal mental health equity grant programs. Press release Section-by-SectionMomnibus Fact Sheet
Aligning for Health: (9/8) - Aligning for Health endorsed the Care That’s Fair Act (H.R. 4554), which seeks to empower states to utilize medical claims data, clinical data and social data to address racial disparities, social determinants of health, and maternal and infant mortality. In the letter, Aligning for Health expressed its agreement that empowering states to harness essential Medicaid claims and clinical data will help identify where social determinants and health disparities exist, which can then be leveraged into action to address these disparities at their root cause.
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 RFI due 9/21!
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.
Department of the Treasury: (9/14) - The U.S. Department of the Treasury announced it has offered the City and County of Denver, CO a Social Impact Partnership to Pay for Results Act (SIPPRA) Project grant for $5.5 million and a SIPPRA Independent Evaluator grant for $826,800 for its Housing to Health (H2H) program. This program is a permanent supportive housing program designed to reduce homelessness and increase housing stability, and the grants will allow more Denver residents who are experiencing homelessness to receive basic housing and health services.
CMS: (9/10) - CMS issued an information bulletin to inform state Medicaid agencies that the United States Department of Agriculture (USDA) Food and Nutrition Service (FNS) is issuing a solicitation for participation in additional demonstration projects for states to evaluate the impact of using Medicaid eligibility data to directly certify students for free and reduced price school meals. The bulletin also reminds states that they are permitted to share Medicaid data to verify a child’s school meal eligibility in accordance with federal Medicaid law. Applications for the 2022-2023 school year must be received by FNS by September 30, 2021.
CMS: (9/10) - CMS announced $20 million in cooperative agreement funding will be awarded to four entities under the Community Health Access and Rural Transformation (CHART) model Community Transformation Track to improve health care in rural areas. The award funds will be used to develop and implement a health care redesign strategy for each awardees’ defined community over the course of the model. The CHART Model is intended to address disparities in health equity by improving access to quality health care and the sustainability of the health care system in rural communities. Alabama press releaseSouth Dakota press releaseTexas press releaseWashington State press release
Healthcare IT News:(9/10) - During the Office of the National Coordinator for Health IT (ONC) Forum, Deputy National Coordinator Steve Posnack reiterated a focus on social determinants of health, health equity, and strengthening public health as key priorities for ONC. In his remarks, Posnack encouraged attendees to consider how they can approach “health equity by design” to build in the concept of health equity as part of the culture of health IT implementation and use.
CMS: (9/9) - CMS Administrator Brooks-LaSure penned a blog post highlighting her actions during her first 100 days, and her strategic vision for CMS moving forward. In the blog, Administrator Brooks-LaSure noted that everything done at CMS should align with one or more of six strategic pillars, one of which includes to advance health equity by addressing the health disparities that underlie the health system.
USDA: (9/8) - The USDA Economic Research Service released its annual report on the state of food insecurity in the nation, which presents statistics on household food insecurity, food expenditures, and the use of Federal nutrition assistance programs in 2020. The data suggests that, despite challenges posed by COVID-19, the share of households experiencing uncertain access to food due to resource limitations remained relatively unchanged from 2019. Just over 10 percent, or 13.8 million households, were considered food insecure in 2020.
HHS ACL: (9/7) - HHS Administration on Community Living (ACL) announced 12 new awards for the 2021 No Wrong Door Community Infrastructure Grants: Scaling Network Lead Entities funding opportunity. The intent of these awards is to provide funding directly to the 12 CBOs to: 1) Establish or enhance a statewide or regional Community Integrated Health Network (CIHN), led by a Network Lead Entity (NLE); 2) Enhance NLE capacity in one or more of the following domains: leadership, finance, business development, network development and support, and network administration; 3) Increase attention to health equity by addressing both equitable access to social determinants of health-related services through a culturally competent and coordinated statewide access system by leveraging a state’s existing NWD System; and (4) Align health care and social services through the enhancement and expansion of NLEs/CIHNs to increase SDOH service availability and delivery.
SDoH in the News
Politico: (9/16) - The growing “farmacy” or “produce prescribing” movement treats fresh produce as a way to promote health, however health systems have long faced barriers and legal limits to spend money on food as medicine for patients. The food system is largely siloed from the health system, and most food-health ventures often depend on grant funding and donations to be sustainable. COVID has driven new interest in increasing access to healthy food, and making healthy food a prescription can directly connect food to health and spur changes in behavior and consumption that promote health.
Health Affairs: (9/16) - Millions of Americans suffer unnecessarily due to lack of access to integrated, affordable, and equitable oral health care, with the impact of the issue not evenly distributed across populations. Rural communities, those living with disabilities, communities of color, and those living in poverty are disproportionately impacted by lack of oral health care. This article outlines how science and innovation are the best shot at leveling the playing field to address health disparities by providing low-cost, scalable solutions to oral health integration and access.
Mass General Brigham: (9/13) - Mass General Brigham announced it is working with 12 community organizations to address unmet needs facing patients and members of the surrounding community, providing over $520,000 in funding to support and partner with these organizations on efforts to address food insecurity, access and capacity. The percentage of those facing food insecurity in Massachusetts has increased 55 percent from 2019 to 2020.
Health Affairs: (9/13) - While telehealth has helped reduce barriers associated with in-person care, it also has potential to exacerbate existing health disparities, as access to telehealth requires the right technology, broadband access, and digital literacy to utilize the service. This blog offers perspectives from clinicians and researchers on the future of telehealth, as well as policy recommendations and advocacy goals for the coming months as policy makers decide which pandemic-era policies to make permanent.
Healthcare Finance: (9/10) - A group of 17 national health care organizations penned a letter to HHS Secretary Becerra, urging him to move forward on alternative payment models (APMs) as part of HHS’ strategy to achieve health equity. The groups highlighted how APMs consistently leverage multidisciplinary approaches to care, assess social risk, and partner with community organizations to increase access to non-medical services and leverage data to improve disparities in outcomes.
Health Affairs: (9/10) - In the latest episode of the Health Affairs This Week podcast, Health Affairs' Director of Health Equity Vabren Watts and Senior Editor Rob Lott discuss the journal's latest efforts to highlight and advance health equity through a new blog cluster, the new Health Equity Advisory Committee, and the Health Equity Fellowship for Trainees.
Center for Health Care Solutions: (9/10) - This blog post focuses on how the Medicaid program can address health-related social needs, outlining four lessons learned by the author on supporting health care stakeholders to meaningfully address unmet needs. The lessons outlined focus on state activities related to advanced primary care and Medicaid managed care.
Businesswire: (9/9) - Humana announced it will invest $25 million into eight states to promote affordable housing through low-income housing tax credits. This effort is part of Humana’s Bold Goal initiative, which aims to address SDOH and health-related social needs. Humana’s housing strategy aims to address members’ housing needs through a three-part approach, including interventions and investments that reduce health care costs and improve outcomes for vulnerable members and communities.
AAMC: (9/9) - In a recent interview with AAMC, former US Surgeon General David Satcher, MD, PhD and ACA expert Daniel Dawes, JD provided insights into health equity throughout history and shared thoughts on a path forward after COVID-19. They both outline policy changes they would like to see to increase equity in health care, as well as what institutions like medical schools can do to promote health equity.
Health Affairs: (9/9) - Despite gains by the ACA to reduce the uninsured rate, over one in five working-age adults are still considered underinsured. Clinically driven payment and benefit designs to encourage access to necessary care for at-risk individuals, particularly in light of high deductibles and cost-sharing, are warranted to address this. This blog highlights the value-based insurance design (VBID) model as one potential strategy to promote equitable access to essential services.
Center for Health Care Strategies: (9/8) - The Center for Health Care Strategies helped inform the development of the Center for Family Voice, which engages Ohio families in the development of programs and policies that directly impact health, education, healthy development, and child wellbeing. This blog outlines seven key considerations for health care organizations, Medicaid programs, and advocacy organizations to facilitate family engagement in program and policy design implementation.
State of Connecticut: (9/8) - Connecticut Governor Ned Lamont announced that his administration received federal approval to combine Medicaid health coverage with a range of housing services for Connecticut residents struggling with homelessness and chronic illness. The Connecticut Housing Engagement and Support Services (CHESS) initiative will pool efforts of state agencies and nonprofit partners to bring coordinated health care and housing supports to individuals with mental health, substance use, and other serious health conditions.
The Physicians Foundation: (9/8) - The Physicians Foundation released recommendations to address SDOH impacting patients and physicians. The 17 recommendations are centered around four key principles to address how health care is paid for and delivered, while reducing costs and administrative burdens on physicians: address SDOH in combating COVID; integrate SDOH into payment policies; create new standards for SDOH quality, utilization, and outcome measurement; and make SDOH central to CMMI and states’ innovation agendas.
US News & World Report: (9/7) - Hospitals and health systems are increasingly engaged in addressing the social determinants of health faced by patients. This article highlights the types of investments health systems are making to address social needs and strategies they are using, such as credible messengers and partnering with community-based organizations to improve patient outcomes and offer a range of services.
Patient Engagement HIT: (9/7) - Deloitte recently unveiled its Deloitte Health Equity Institute to advance the company’s goal of aggregating health disparities data and partnering with business leaders. Kulleni Gebreyes, MD, the leader of the Institute, said health care organizations can divide their health equity work into four domains to ensure organizational culture emphasizes equity at all junctures: the organization, offerings, community, and ecosystem.
Healthcare Strategies Podcast: (9/6) - On this episode of the Healthcare Strategies Podcast, Sara Heath, managing editor at Xtelligent Healthcare Media, reviews how to define health equity, how the pandemic impacted the industry-wide discussion around the topic, and steps that organizations can take toward improving health equity.
New Research and Reports
Modern Healthcare: (9/15) - A report by the U.S. Commission on Civil Rights highlighted how maternal mortality in the United States has worsened over the past three decades, largely due to increased disparities in access to quality perinatal care among women of color. The report found that the maternal mortality rate rose from 6.6 deaths for every 100,000 live births to 20.1 deaths for every 100,000 live births from 1987 to 2019. Black women are three to four times more likely to die from pregnancy-related complications compared to white women, and had the fastest escalation in deaths between 2007 and 2014.
Trust for America’s Health: (9/15) - Trust for America’s Health (TFAH) released its annual State of Obesity report, which provides a snapshot of rates of overweight and obesity by age, race/ethnicity, and state of residence for US adults. In 2020, 16 states had adult obesity rates at or above 35 percent, up from 12 states in 2019 and likely due to COVID-19 impacts on eating habits, worsened levels of food insecurity, and obstacles to physical activity. TFAH calls for addressing social determinants of obesity through policies like ensuring access to no cost healthy school meals, among other recommendations.
Medscape: (9/12) - A recent assessment found that measures of greater food insecurity, including poor access to grocery stores for seniors or food deserts, are independently associated with increased heart failure mortality in the US. The effect of food insecurity on nutrition is likely a contributor to this finding, however other socioeconomic factors are typically at play alongside food insecurity.
NIMHD: (9/9) - The National Institute on Minority Health and Health Disparities (NIMHD) released new social determinants of health assessments collections that introduce standard measures for SDOH and encourage cross-study analysis to increase the impact of individual studies. The thirty specific research strategies across the three pillars that guided the science visioning to transform minority health and health disparities – methods and measurement, etiology and interventions – establish a new paradigm to stimulate research for improving minority health and closing the gaps in health disparities.
Patient Engagement HIT:(9/8) - New research from the Massachusetts General Hospital found that team-based care received in community health centers helped low-income Hispanic kids in a pediatric weight management program more so than children receiving traditional care. Kids from low-income homes or racial minorities often face barriers to care, making it hard for caregivers or health care providers to facilitate care management. These results demonstrate how convenient care access can aid in chronic disease prevention for this population.
Root Cause Coalition: (9/7) - The Root Cause Coalition published data from its latest consumer insights survey, which looked at perceptions of poverty in the US and understanding of social determinants of health. Among findings include that while the majority of those surveyed indicated that neighborhood has a large impact on whether one lives in poverty, over half reported no familiarity with life expectancy gaps based on one’s zip code. Additionally, over three-quarters of Americans say they are somewhat familiar with the term “systemic racism,” and just under three-quarters said they are somewhat familiar with the term “health equity.”
NASHP: (September 2021) - The National Academy for State Health Policy (NASHP) featured a July report by the Kansas Governor’s Commission on Racial Equity and Justice, which focused on social determinants of health. The report emphasizes early childhood and childcare needs as critical components to advancing racial equity across the state. Recommendations in the report include incorporating the science of adverse childhood experiences (ACEs) into policy making decisions and establishing a public-private partnership that helps meet the needs of children and families.
Health Affairs: (September 2021) - This study looks at nationally representative data from 2013-2018 to investigate the prevalence of food insecurity among health care workers. Researchers found that the odds of being food insecure were 5.1 times higher for health care support workers and 2.5 times higher for health technologists and technicians, compared to health diagnosing and treating practitioners.
Robert Wood Johnson Foundation: (September 2021) - The Robert Wood Johnson Foundation’s State Health and Value Strategies program published a guide to support states in advancing health equity in the Medicaid managed care delivery system. The guide looks at steps states can take to establish equity as a core principle of Medicaid, change organizational policies and operations, and leverage managed care to advance health equity.
Center for Health Care Strategies: (September 2021) - Effective trauma-informed care requires a nuanced understanding of both how trauma, like racism, impacts the lives and care of patients and the root causes behind the trauma. This issue brief provides considerations for health systems and health care providers on how to incorporate a focus on racial equity to enhance trauma-informed care efforts, drawing from the experiences of two federally qualified health centers in Philadelphia and D.C.
Health Affairs: (September 2021) - This study looked at the relationship between the COVID relief funding received by over 2,700 hospitals and community- and hospital-level characteristics, finding that funding through early February 2021 averaged $25.7 million per hospital. These findings presented a mixed picture and an uneven distribution of relief funds. While some correlates of real-world need (i.e. serving a community with a high share of Black residents) were associated with meaningful funding increases, others (i.e. a Medically Underserved Area) were associated with decreased or no difference in funding.
Bipartisan Policy Center: (September 2021) - The Bipartisan Policy Center’s Food and Nutrition Security Task Force produced the first brief in a series of three that provides recommendations for bipartisan, consensus-based approaches for improving food and nutrition security during COVID and the economic recovery. Implementation of the nine policy recommendations in this brief can also support food and nutrition security during future public health emergencies, economic downturns, and recessions.
Data and Innovation
EHR Intelligence: (9/16) - DirectTrust announced the launch of the Information Exchange for Human Services (IX4HS) Consensus Body to support social determinants of health data exchange interoperability. The consensus body will evaluate the Direct Standard and other existing standards for SDOH data exchange between health care settings and human service organizations, creating new standards as needed.
Health IT Analytics: (9/10) - Incorporating social determinants of health into artificial intelligence (AI) capabilities has the potential to help providers see improved risk identification, improved patient outcomes, and a decrease in health disparities among underserved populations. This article examines these three areas in more detail to show how SDOH data can enhance AI and patient outcomes.
Health Affairs: (9/9) - Harnessing quality measurement as a tool for advancing a more equitable health care system has the potential to decrease costs, improve outcomes, and promote equity in health care, among other promising aspects. Realizing this potential requires providing transparency into existing disparities in care. Stratifying data by race and ethnicity in health plan quality measure sets can catalyze health plan efforts to collect race and ethnicity data, bring transparency to existing disparities in care and outcomes, and highlight plans that successfully invest in strategies to reduce those disparities.