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: (8/19) - In the latest episode of the American Hospital Association Members in Action podcast, Nicole Lamborne, MD, vice president of clinical operations for women’s services at Virtua Health in New Jersey, shares how the health system identified gaps in maternal care and invested in laborists, nurses, and evidence-based practices to lower C-section, hypertension, hemorrhage, and sepsis rates.
Unite Us:(8/17) - Unite Us announced the acquisition of Carrot Health, the nation’s premier action-oriented health analytics company focused on removing barriers to health and optimizing care. This adds to Unite Us’ interoperable end-to-end solution, which includes its flagship outcomes-focused national care coordination platform, prediction and enrollment capabilities, and payments products to reimburse community-based organizations for their impact.
Health Leaders Media: (8/16) - CareFirst BlueCross BlueShield, a health plan of BlueCross Blue Shield Association (BCBSA), is one payer that is investing in alternative data as part of a broader investment in better health outcomes for individuals and communities. CareFirst plans to use alternative data, which is any data external to what a company collects on its own, to design interventions that incorporate social determinants of health.
CareSource: (8/12) - CareSource believes it is their collective responsibility to take action and create an environment of empathy for how they serve the most vulnerable in order to address health equity. This article outlines CareSource’s commitment to achieving health equity for all its members, which includes actions such as advocating for and driving change and raising awareness for health disparities and removing barriers to health equity.
JAMA Network Open: (8/11) - This study looked at the characteristics and outcomes associated with giving birth with COVID-19 over the first year of the pandemic in the US. Using the Vizient Clinical Data Base/Resource Manager (CDB/RM), the study compared characteristics (including demographic characteristics, gestational age, and comorbidities) and outcomes of women who underwent childbirth with versus without COVID between March 1, 2020 and February 28, 2021. The study found that pregnant women with COVID-19 had higher rates of mortality, intubation, ICU admission, and preterm births than pregnant women who did not have the virus.
Newswise: (8/11) - Cedars-Sinai launched the Community Connect Program to boost screening for patients with health-related social needs. Cedar-Sinai also has a separate, public-facing version of the tool called CS Community Resource, which was developed in partnership with Aunt Bertha and available for patients to look for free or reduced-cost resources in categories such as food, housing, transit, education, and more.
CareSource: (8/10) - In Georgia, maternal death rates for white women are twice that of the national rate, and Black women are twice as likely as white women to face maternal death, a statistic that is exacerbated by the lack of providers who come from and reside in communities of color. To address the maternal mortality rate in the state, CareSource is focused on improving Georgia’s maternal health through providing resources for locating health services and transportation to remove barriers from proper health treatment.
Health Payer Intelligence: (8/10) - Centene uses a machine-learning algorithm to help identify members that may want to get the vaccine but experience social determinants of health barriers in doing so, including by taking vaccination center placement and transportation barriers into account. Partnerships with companies like Lyft have helped address such barriers to ensure members are able to get the vaccine.
Senate Finance Committee: (8/18) - Senate Finance Committee Chair Ron Wyden (D-OR) announced he will introduce the Decent, Affordable, Safe Housing for All (DASH) Act, which will make a generational investment to house all people experiencing homelessness, tackle the housing affordability crisis, and expand homeownership opportunities for young people by creating a new down payment tax credit for first-time homebuyers. Bill textSummarySection-by-section
Community Catalyst: (8/17) - On August 17, 212 organizations sent a letter to House and Senate leadership urging them to take meaningful action to address the inequities that birthing people of color face, specifically Black and Indigenous women. The groups outlined their support for a number of priorities, including: ensuring coverage for birthing people; building out maternal health services that center racial equity; and investing in community-based partners. Each of these three priorities was accompanied by a set of recommendations for how Congress could address each issue.
DIVERSE Trials Act: (8/13) - Sens. Menendez (D-NJ) and Scott (R-SC) introduced the Diversifying Investigations Via Equitable Research Studies for Everyone (DIVERSE) Trials Act (S. 2706), which would improve diversity in clinical trials and data collection for COVID-19 and future public health threats to address social determinants of health. Reps. Ruiz (D-CA) and Buchson (R-IN) introduced companion legislation in the House (H.R. 5030). Bill text
Language Access for Medicare Beneficiaries Act: (8/13) - Rep. Gomez (D-CA) and 14 cosponsors introduced the Language Access for Medicare Beneficiaries Act of 2021 (H.R. 5012), which would provide for enhanced Medicare beneficiary information through access to annual Medicare notifications in multiple languages.
Addressing SILO Act: (8/10) - Rep. Sanchez (D-CA) introduced the Addressing Social Isolation and Loneliness in Older Adults (SILO) Act of 2021 (H.R.5005), which would provide grants and training to support area agencies on aging or other community-based organizations to address social isolation among vulnerable older adults and people with disabilities.
Choice Neighborhoods Initiative Act: (8/7) - Sens. Menendez (D-NJ) and Van Hollen (D-MD) introduced the Choice Neighborhoods Initiative Act of 2021 (S.2672), which would authorize the Department of Housing and Urban Development to transform neighborhoods of extreme poverty into sustainable, mixed-income neighborhoods with access to economic opportunities, by revitalizing severely distressed housing, and investing and leveraging investments in well-functioning services, educational opportunities, public assets, public transportation, and improved access to jobs. Reps. Cleaver (D-MO), Mfume (D-MD), DeGette (D-CO) and Evans (D-PA) introduced companion legislation in the House (H.R. 4948).
Livable Communities Act: (8/6) - Sen. Menendez (D-NJ) and seven cosponsors introduced the Livable Communities Act of 2021 (S. 2616), which would create livable communities through coordinated public investment and streamlined requirements. Specifically, the bill would help working families access good paying jobs by ensuring affordable housing is connected with transit systems through establishing an Office of Sustainable Communities within HUD to promote interagency coordination on the development of affordable housing, transit systems, and other community needs, among other provisions.
To view a full list of the legislation we are tracking around social determinants of health, health equity/disparities, and maternal health, click here.
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Western Governors Association: (8/18) - Western Governors voiced their support for the Social Determinants Accelerator Act of 2021 in recent correspondence to the House Energy & Commerce Committee. The letter, which was signed by Western Governor Association Chair Idaho Gov. Brad Little and Vice Chair Colorado Gov. Jared Polis, referenced the bills planned allocation of $25 million to establish a Social Determinants Accelerator Interagency Council and grant program, asserting that “these plans would facilitate the implementation of locally designed, cross-sector interventions and strategies and provide important data on the cost-effectiveness and outcomes of these innovative approaches.”
HHS: (8/18) - The Biden-Harris Administration announced key investments that will strengthen telehealth services in rural and underserved communities and expand telehealth innovation and quality nationwide. These investments, which total over $19 million, will be distributed to 36 award recipients through HRSA for activities such as building sustainable tele-mentoring programs and networks in rural and medically underserved communities and assessing telehealth strategies and services to improve health care in such areas with high rates of chronic disease and poverty.
AHRQ: (8/16) - Members of the Agency for Healthcare Research and Quality (AHRQ) National Advisory Council wrote a blog post calling for action to achieve health equity, highlighting the need to understand that there is no health care quality without health care equity and that future quality measures should be considered through the contexts of systemic racism and equity. The authors also highlight how AHRQ research can help provide the keys and tools needed to understand individuals more holistically to better address social determinants of health and keep patients at the center of care.
USDA: (8/16) - The US Department of Agriculture (USDA) released a re-evaluation of the Thrifty Food Plan, which is used to calculate SNAP benefits. The evaluation found that the cost of a nutritious, practical, cost-effective diet is 21 percent higher than the current Thrifty Food Plan. As a result, the average SNAP benefit (excluding additional funds provided as part of pandemic relief) will increase by $36.24 per person, per month (or $1.19 per day) for Fiscal Year 2022 beginning on October 1, 2021.
HHS ONC: (8/11) - The HHS Office of the National Coordinator for Health Information Technology (ONC) issued a blog of the 2021 Leading Edge Acceleration Projects (LEAP) in Health IT awardees. The two projects include creating referral management to address social determinants of health (SDOH) aligned with clinical care, and health IT tools to make electronic health record data research and artificial intelligence ready.
SDoH in the News
Health Affairs: (8/17) - Health Affairs announced the formation of its Health Equity Advisory Committee, which will help guide the journal in advancing racial equity as outlined in the Blog “Dismantling Racism in Scholarly Publishing, Intentionally and Unapologetically.” The Committee will serve as representatives for health services and policy researchers, provide extrospective views of equity issues in scholarly publishing, and guide Health Affairs in its equity initiatives that support researchers who belong to historically marginalized populations or who are improving equity in health policy research.
Utah Business: (8/16) - Intermountain Healthcare announced a partnership with Rocky Mountain Homes Fund to provide affordable, stable housing options in Weber County, Utah. The Rocky Mountain Homes Fund offers an intermediary step for low- to moderate-income families that helps put them on a path to homeownership. Intermountain Healthcare’s investment in this Fund is part of its larger Alliance for the Determinants of Health effort to address SDOH in underserved communities.
MedCity News: (8/12) - Hackensack Meridian Health in New Jersey announced a partnership with NowPow to establish a program to connect patients in need with community resources. The NowPow platform is embedded in the health system’s EHR, allowing care teams to screen patients for social factors that may be negatively affecting their health and provide referrals to community-based resources to address those needs. Since June 28, when the platform went live, over 80,000 patients have been screened and over 21,000 referrals have been issued.
Milbank Memorial Fund: (8/12) - Few aspects of racial injustice and inequity in the United States are better documented than racial inequity in health care. Real-time quality data that includes a patient’s race and ethnicity for all types of health care and health care settings is needed to truly eliminate inequity in health care. “For real change to occur, we need more than periodic national surveys or isolated, localized studies of specific topics or care settings of interest to particular funders,” said Sara Rosenbaum, author of this blog.
HIT Consultant: (8/12) - The American Medical Association (AMA) announced the creation of an external advisory group called the Equity and Innovation Advisory Group, which is dedicated to advising the AMA on how to advance equity in health care innovation. The advisory group will recommend strategies that will help drive equitable resources to health solutions created by marginalized innovators and include marginalized patients’ voices in the health innovation development process. The goal is to achieve measurable improvement in health outcomes and reduction of health inequities within marginalized populations.
US News & World Report: (8/12) - US News & World Report developed new measures aimed at capturing how effectively hospitals contribute to racial health equity in their communities, including an assessment focused on hospitalizations for conditions like asthma, diabetes, or high blood pressure. Overall, 229 hospital service areas (HSAs) representing 645 hospitals landed in the best category available for at least one of the three preventive care metrics, yet Black beneficiaries were moderately to substantially more likely than non-Black beneficiaries to be hospitalized with these conditions in over 70 percent of HSAs analyzed.
WTHR: (8/11) - Indiana Governor Eric Holcomb launched an online dashboard that shows current equity gaps that exist in health, public safety, social services, education, and workforce across the state, in order for the governor’s office to better focus its efforts to address such inequities. As the state develops a plan to drive change in government culture and operations, one such action that is already underway is with the state’s talent development system to include more opportunities for people of color.
Healthcare IT News: (8/11) - A key topic of conversation at this year’s HIMSS21 conference was health disparities and addressing the structural inequities that contribute to them. Health IT leaders and executives on multiple panels offered perspectives on how to address such inequities and how technology could help. Actions such as collecting comprehensive data, garnering executive buy-in, and fostering industry collaboration are key to meet the needs of the population at the individual level through traditional care delivery, community partnerships, and technological interventions.
Brookings Institute: (8/9) - This article examined changes in homelessness rates from 2007 to 2020 to gain insight into how homelessness changes over macroeconomic cycles. The analysis focused particularly on four metro areas that were hard hit by the 2007 foreclosures sparked by the recession during that time, and found that homelessness rates declined over time in three of the four areas but that the share of unsheltered homelessness has been increasing in recent years.
New Research and Reports
Brookings Institute: (8/17) - The term “food desert” gave rise to new indices and a push to bring fresh food directly to underserved neighborhoods, however there are structural issues with the concept itself given the narrative does not address the primary factor of financial insecurity as driving food insecurity. This report looks at how to update the concept of geographic food access for today’s digital economy and consider policies that will marry the need to increase people’s buying power with their ability to get the food they need.
New York Times: (8/17) - According to a new series of studies published in the journal JAMA, the racial health gap remains despite improved access to care due largely to the Affordable Care Act reducing the number of uninsured across all racial and ethnic groups. One issue devoted to inequities in medicine also pointed to persistent health disparities on a range of issues from research on spending and patterns of care, comparative rates of gestational diabetes, and the proportion of Black physicians at medical school. The series offers studies on disparities in the utilization of health care services and in overall health spending, and shows that who benefits from advancements in science and medicine varies by race and ethnicity.
Patient Engagement HIT: (8/16) - A study published in JAMA Network Open found that current SNAP benefits are not enough to address food insecurity. The study found that providing an additional $40 per month to SNAP beneficiaries through the SuperSNAP program for the purchase of fruits and vegetables was associated with healthier eating habits and a decrease in the purchasing of less healthy foods. These findings led researchers to suggest that increasing SNAP benefit amounts and incentivizing beneficiaries to purchase healthier foods through government programs can improve health outcomes.
Journal of Public Health Management & Practice: (8/14) - In early 2020, the CDC partnered with the National Association of County and City Health Officials (NACCHO) and the Association of State and Territorial Health Officials (ASTHO) to identify multisector coalitions that have improved social determinants of health in their communities. Using the five domains for SDOH in Health People 2030, the CDC’s National Center for Chronic Disease Prevention and Health Promotion developed an integrated framework to address SDOH in areas with the greatest potential to impact chronic disease outcomes. This article outlines more on the Social Determinants of Health - Getting Further Faster pilot project resulting from this framework.
mHealth Intelligence: (8/13) - A study published in the Telemedicine and e-Health Journal found that telehealth has the potential to increase access to health care services and improve health outcomes for people experiencing homelessness. Researchers at Medical University of South Carolina gathered data from a community health clinic serving homeless residents in an urban southern city, which offered both in-person and telehealth services. Telehealth yielded an overall satisfaction rate of 92.7 percent from this population, and had telehealth not been an option, 38.2 percent of those surveyed said they would not have sought care and 29.1 percent would have instead gone to the emergency room.
BMJ Open Quality: (8/10) - Over two-thirds of hospitals do not screen for social risk factors that indicate individual-level adverse social determinants of health, despite the widespread acceptance that such factors impact health outcomes. This study looks at a project to implement the Core 5 social risk screening tool and evaluate its efficacy and usability in identifying social risk factors in a presurgical spine population. Results indicated that the screening tool identified patients with social risk factors and staff reported perceptions of efficacy and usability in a clinical workflow. About 60 percent of patients in this population were effectively screened and 10 percent had identified social needs that needed to be addressed prior to surgery.
Trust for America’s Health: (8/9) - Trust for America’s Health (TFAH) published an issue brief outlining current housing challenges faced by older adults and potential areas for public health interventions. The report summarizes existing programs that offer housing support for older adults and offers recommendations in each of the five key roles for public health.
Preventive Medicine: (August 2021) - Health care stakeholders are increasingly investing in social determinants of health to improve health outcomes and reduce total cost of health care in their communities. This study looked at federal lobbying disclosures from the ten highest spending health insurance and health care provider organizations and related associations between 2015 and 2019 to identify lobbying reported on salient SDOH issues. Five of the organizations reported lobbying on some SDOH issues, including financial strain, employment, food insecurity, and interpersonal safety, but none reported lobbying on other issues, highlighting an opportunity for such organizations to expand their lobbying upstream on SDOH policy issues to increase the impact of their SDOH strategy.
Data and Innovation
EHR Intelligence: (8/16) - North Coast Health Improvement and Information Network (NCHIIN) announced a new health IT partnership with QS Systems to implement its community information exchange (CIE) platform, NinePatch, to boost SDOH data interoperability. The team-based care coordination platform will help the HIE connect fragmented data sectors through a variety of interoperability tools, and will provide coordinated information sharing and closed-loop referral processes across medical, behavioral, and social health domains to boost patient-centered care delivery.
Health IT Analytics: (8/12) - Parkview Medical Center and Pieces Technology used data analytics to address social determinants of health and decrease the average length of stay rates among patients. Parkview examined social determinants of its patients through data analytics to determine factors impacting population health and a patient’s length of stay, and examined a partnership with Pieces Technology to expand their artificial intelligence capabilities and provide more efficient care for patients.
Health Affairs: (8/11) - Authors of this blog conducted state-level maternal health interviews and combined key findings with priority actions around data quality and timeliness of the HHS maternal health action plan released in December 2020, along with current efforts of the Office of the Secretary Patient-Centered Outcomes Research Trust Fund (OS-PCORTF) projects, to develop a set of principles to advance patient-centered outcomes research (PCOR) data infrastructure for maternal health efforts. Those principles include: recognizing the value of data infrastructure for PCOR that informs decisions to improve maternal health; prioritizing efforts to bolster data infrastructure including data collection, linkage, and data sharing to support PCOR; and minimizing data and research silos and expanding collaboration across stakeholders.
EHR Intelligence: (8/9) - Cerner announced a new EHR integration, Cerner Determinants of Health, that leverages health IT to identify social determinants that contribute to health disparities. The Cerner Determinants of Health dashboard and supporting set of tools aim to help clinicians pinpoint social services gaps and suggest goals and resources within the patient’s care plan to target opportunities for intervention.