Highlights

• House Appropriations Committee advances FY2023 Labor-HHS-Education funding bill, which contains key SDOH report language

• Congressional SDOH Caucus to hold a briefing on food insecurity on July 13

• CMS CY2023 Physician Fee Schedule includes RFI on two SDOH outcome measures for ACOs

• HHS seeks information on strengthening primary care to promote health equity

• ONC HITAC discusses key themes in hearing about health equity by design

• NIH All of US program dataset adds insights from SDOH survey and health disparities

Member News

BCBSA: (7/7) - The Blue Cross Blue Shield Association (BCBSA) is addressing some of the most pressing health care issues in America, and continued to advance and elevate health equity conversations among key stakeholders via a variety of hosted sessions at Aspen Ideas: Health. BCBSA led and participated in a variety of sessions surrounding health equity, maternal health and mental health at this conference, a roundup of which is described in this blog.

3M: (7/6) - This blog by 3M outlines that since the SDOH movement has gained momentum in health care, there is a strong drive to take a more active role in identifying and treating a person’s socioeconomic and psychosocial well-being. The blog touches on how SDOH is a systematic problem, and that collaboration between government, health care, communities and individuals is key to whether we successfully address SDOH.

findhelp: (6/30) - findhelp announced a partnership with Uber Health to offer customers a way to order flexible ride services for their patients experiencing transportation barriers. A patient can schedule an Uber ride for their preferred date and time to reliably get where they need to go, whether that be for clinic visits, discharge from hospital, social care needs, or otherwise.

Healthcare Business Today: (6/30) - One of Healthy People 2030’s principles is the “health and well-being of all people and communities are essential to a thriving, equitable society.” To advance health equity for all—including the older adult population—we must provide access to quality, timely health care, and manage their SDOH through social care coordination that affords easy access to services they need. This blog, authored by Unite Us staff, outlines five essential strategies to improve social determinants of health to support healthy aging.

Healthcare Innovation: (6/28) - UPMC launched a Pathways to Work initiative to provide training, education, and direct support to increase access to employment for UPMC Health Plan members in July 2020. Part of this effort is UPMC’s Freedom House 2.0, which is designed to train and employ first responders from economically disadvantaged communities. The program successfully employs about 200 of its Medicaid members per month into the ranks of UPMC and takes an innovative approach to addressing SDOH.

Health Leaders: (6/20) - Healthy Alliance is one of the few companies that has adapted the medical independent practice association (IPA) model to meet social needs. Payers, providers, community-based organizations, and other stakeholders can use its model to address social needs. Health Leaders interviewed Healthy Alliance leadership to discuss how social IPAs support different stakeholders, how they contract with payers, and steps required to become a social IPA.

Legislative Updates

End Veterans Homelessness Act: (7/7) - Reps. O’Halleran (D-AZ) and Levin (D-CA) introduced the End Veteran Homelessness Act (H.R. 8313), which would make certain improvements to the supported housing program for veterans known as the US Department of Housing and Urban Development - VA Supportive Housing (HUD-VASH) Program by expanding it to more veterans, reducing the number of homelessness veterans and increasing the utilization of vouchers.

House Appropriations Committee: (6/30) - The House Appropriations Committee approved the FY2023 Transportation, Housing and Urban Development, and Related Agencies funding bill (H.R. 8294), which would provide $90.9 billion in funding and support initiatives that address housing and homelessness, among other areas.

House Appropriations Committee: (6/29) - The House Appropriations Committee approved the FY2023 Labor, Health and Human Services, Education, and Related Agencies appropriations bill (H.R. 8295) on a 32 to 24 vote. The bill provides $242.1 billion in funding. Notably, the report accompanying the bill included notable language to support forward movement in addressing social determinants, health equity, and maternal health. This includes a request of $100 million to fund the CDC Social Determinants of Health Program, a request for a briefing by CMS on the current utilization of Z codes for SDOH, a request of $10 million for HRSA to create an innovation fund for community-based organizations to support reducing maternal mortality and adverse maternal outcomes, and other notable provisions. Aligning for Health compiled a summary of notable report language related to SDOH, which can be found here.

Health Equity and Accountability Act: (6/23) - Sens. Booker (D-NJ), Warnock (D-GA), and nine cosponsors introduced the Health Equity and Accountability Act (S. 4486), which would improve the health of minority individuals and provide a roadmap to eliminate racial and ethnic health inequities. The bill lays out additional investments Congress must take to enhance the health and well-being of systematically marginalized and underserved communities, address health disparities, and ensure access to high quality and affordable care.

To view a full list of the legislation we are tracking around social determinants of health, health equity/disparities, and maternal health, click here.

Administration Updates

CMS: (7/7) - CMS issued the CY2023 Physician Fee Schedule proposed rule, which would significantly expand access to behavioral health, ACOs, cancer screening, and dental care. CMS is proposing a health equity adjustment to an ACO’s quality performance category score to reward excellent care delivered to underserved populations. CMS is also requesting information on the use of two social determinants of health eCQM/MIPS CQM outcome-oriented measures for ACOs, which would assess providers on the percentage of individuals screened for social needs. MSSP Fact Sheet General Fact Sheet QPP Fact Sheet

HHS Office of Minority Health: (7/5) - In its new five-part blog series, the HHS Office of Minority Health (OMH) follows up with presenters from its 2020 virtual symposium on COVID-19 on how they have continued to positively impact the communities they serve during the evolving pandemic. The first blog features Matías Valenzuela, PhD, Director of the Office of Equity and Community Partnerships for Public Health in Seattle & King County and the Director of COVID-19 Community Mitigation and Recovery, who discusses how King County has continued to address social justice and health equity issues throughout the COVID-19 pandemic.

Health Affairs: (7/5) - In support of its health equity work, the CMS Innovation Center conducted a review of three existing experimental payment and service delivery models to determine whether implicit bias may be present and, if so, whether such bias has led to the unintentional exclusion of certain beneficiary groups from the models. The results of this analysis, discussed in this blog by CMS Innovation Center staff, are informing broader efforts to address bias across the Innovation Center’s models to achieve health equity.

ONC: (6/30) - The Office of the National Coordinator for Health IT (ONC) published a blog on key themes from ONC’s Health Information Technology Advisory Committee (HITAC) hearing in March 2022 on health equity by design, which include: consistent, equitable data collection and interoperability challenges; the digital divide; and artificial intelligence considerations, including transparency and the importance of identifying bias and curtailing its impacts.

HHS: (6/30) - HHS approved Washington state’s extension of Medicaid and CHIP coverage for 12 months after pregnancy. As a result, up to an additional 12,000 people annually will now have access to Medicaid or CHIP coverage for a full year after pregnancy. With this approval, an estimated 265,000 Americans annually in 15 states and D.C. have gained access to 12 months of postpartum coverage.

ONC: (6/28) - ONC announced the publication of the Approved Standards for 2022 as part of the annual Standards Version Advancement Process (SVAP). SVAP provides an accelerated pathway for health IT developers to adopt the social determinants of health and sexual orientation and gender identity (SOGI) data standards from the United States Core Data for Interoperability version 2 (USCDI v2), one of the notable standards approved for the 2022 SVAP cycle. Additional Information

CMS: (6/30) - CMS announced selected participants for the revamped Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model.

White House: (6/30) - The White House issued a fact sheet on health sector leaders joining the Biden Administration in its pledge to reduce greenhouse gas emissions by 50 percent by 2023. The pledge was signed by 61 organizations, leading health sector suppliers, and major medical associations. HHS also issued a press release outlining private health sector commitments to reduce climate impacts and protect public health.

HHS: (6/27) - HHS released a request for information as part of its Initiative to Strengthen Primary Health Care. The goal of the initiative is to develop a federal foundation for the provision of primary health care for all that supports improved health outcomes and advanced health equity. The first step is to produce an initial HHS Action Plan in 2022. Comments are due by August 1, 2022.

CMS: (6/27) - CMS announced the new, voluntary Enhancing Oncology Model (EOM). The model will focus on supporting and learning from cancer patients, caregivers, and cancer survivors while addressing inequities and providing patients with treatments that address their unique needs. EOM is set to launch on July 1, 2023 and will be a five-year model test. The application period is currently open through September 30, 2022. Fact Sheet

NIH: (6/23) - The National Institutes of Health’s (NIH) All of Us Research Program recently released its dataset of COVID-19 information and has added more than 57,600 initial responses from its new social determinants of health survey to drive novel insights into how lived experiences affect health. Responses to the survey can be paired with select data from the Census Bureau’s American Community Survey linked to participants’ first three digits of their zip code, as well as the program’s other surveys on health care access, lifestyle, social support, and discrimination.

NIH: (6/21) - The NIH Office of Nutrition Research (ONR) issued a notice of special interest to encourage research on the efficacy of interventions that address nutrition security and the mechanisms of food insecurity on a variety of health outcomes. It also calls for the development of new measures for nutrition security and assessment of food insecurity that are broadly applicable. The notice was developed by the ONR Implementation Working Group on Nutrition and Health Disparities in collaboration with NIH Institutes and Centers (ICs) and Offices in support of the goals and objectives of the Strategic Plan for NIH Nutrition Research.

SDoH & Health Equity in the News

Center for Health Care Strategies: (7/7) - The Center for Health Care Strategies recently spoke to Ben Danielson, a pediatrician, Nikki Montgomery, a family advocate, and Mary Catherine Beach, a researcher and professor, to discuss the impact of stigmatizing language in medical records for pediatric patients and their families. This article provides insights and actionable suggestions for clinicians, health systems, and medical education to address bias in medical records.

Health Affairs: (7/1) - To move from accountability for health care to accountability for health and health equity, we must address the drivers of health (DOH) - critical comorbidities such as food insecurity and housing instability. This article describes an actionable DOH measurement vision and pathway - starting with CMS enacting the first-ever federal DOH measures - to make visible and address the impact of these factors on health disparities, outcomes, and costs.

AJMC: (7/1) - Panelists of a keynote session at AHIP 2022 discussed how lessons learned from investment and infrastructure in public health during COVID-19 can be leveraged to promote equitable care for all Americans. Panelists also noted the importance of paying attention to the social needs of individuals and that interventions are needed on the policies that cause an upstream effect on such issues to better address social needs.

ACP Internist: (July 2022) - As recognition of the impact of addressing social determinants of health grows, a growing number of screening tools have been developed and used for health care professionals to determine a patient's SDOH. This article outlines the tools available for providers to use to track SDOH, including the CMS Accountable Health Communities Health-Related Social Needs Screening Tool, the PRAPARE Screening Tool, ICD-10 Z codes, and more.

Association for Community Affiliated Plans: (6/30) - The Association for Community Affiliated Plans (ACAP) launched the ACAP Center for Social Determinants of Health Innovation, which offers tailored resources, including policy reports, market research, and roundtable educational events, to help health plans, policymakers, and other stakeholders address social issues that impact health and wellbeing. The Center will encourage and empower other stakeholders to support SDOH initiatives.

Nemours Children’s Health: (6/29) - Nemours Children’s Health launched the Whole Child Health Alliance to advance whole child health models that promote children’s optimal health, development and well-being across the life course while improving health equity through delivery and payment reforms. Whole child health models engage child health providers, payers, community-based organizations and other multisector partners in improving population health and addressing social needs and broader social determinants of health affecting children, youth and their families. Aligning for Health is proud to be a member of this new initiative!

AJMC: (6/28) - On this episode of Managed Care Cast, AJMC speaks with Georges C. Benjamin, MD, executive director of the American Public Health Association, on the core takeaways of his keynote session at AHIP 2022 on public health policy and other solutions to promote equitable health and well-being.

Managed Healthcare Executive: (6/27) - Medicaid managed care organization (MCOs) may be better equipped to address SDOH and health equity than payers who use fee-for-service models, as SDOH are central to many requirements for MCOs. For providers to effectively deliver value-based care and proactively minimize health risks, they need to understand how SDOH are impacting their members, but getting that data and assessing it to provide optimal care can present a challenge.

Health IT Analytics: (6/27) - The Rutgers Center for State Health Policy launched the New Jersey Integrated Population Health Data (iPHD) Project to help address some of the state’s major population health issues. The project’s current research priorities include social determinants of health and maternal and infant health, among others.

Modern Healthcare: (6/27) - When it comes to expanding the approach to cost-effectiveness to encompass health, not just health care, we are at a crossroads. In this op-ed, Joseph Fifer of Healthcare Financial Management Association outlines three options to address social determinants of health: maintain the status quo, decline to be part of the solution, or take action to invest in SDOH.

Washington Post: (6/26) - There are over 11,000 older adults who are considered food insecure in D.C. – the city with the highest rate of senior food insecurity in the country according to Feeding America. While D.C. has launched several supporting programs to help seniors access healthy meals, some have fallen through the cracks. Outreach to attract new enrollees to the programs is insufficient, with isolation and poverty serving as factors.

NEJM Catalyst: (6/24) - This article outlines key components of the Vanderbilt Medical Center’s Racial Equity Plan, which includes more than 100 specific actions the organization is taking to confront racism. The plan is organized into eight thematic areas and is intended to be a road map in which every action has a leader responsible and accountable for that action, with specific milestones and metrics along the way.

 Spotlight on Maternal Health 

Healthcare IT News: (7/7) - In this episode of HIMSS TV, Uma Ahluwalia, managing principal at Health Management Associates, says that local and state governments are key to implementing effective policies for maternal and infant health.

Virginia Mercury: (7/5) - Virginia Medicaid will begin to cover enrollees for a year after childbirth, an expansion that is aimed at improving postpartum outcomes for low-income patients. This change has been in the works since 2020 when state legislators passed budget language directing the Virginia Department of Medical Assistance Services to initiate the expansion, and despite not being approved by the federal government until November, will go into effect this month.

Health Day: (7/4) - According to new research from the U.S. National Center for Health Statistics, the death rate for pregnant and early postpartum women increased by 18 percent in 2020, with even higher increases experienced among Black and Hispanic women. There was also evidence of new disparities, including a 40 percent increase in already high rates for Black women and a 74 percent increase among formerly lower rates in Hispanic women. COVID was listed as a secondary cause of death in almost 15 percent of maternal deaths in the last nine months of 2020.

Milbank Memorial Fund: (6/30) - In the wake of the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, state officials and their community partners should act on longstanding, shared commitments to improving maternal health and eliminating racial disparities. This article outlines ways this can be done, including by maximizing use of Medicaid coverage options that have been demonstrated to improve outcomes such as extending Medicaid coverage to one year postpartum, and refreshing themselves on evidence and experience related to pregnancy and racial disparities in the U.S.

University of Minnesota: (6/30) - Researchers at the University of Minnesota School of Public Health looked at how risk for maternal morbidity and death differs for people giving birth who were insured by Medicaid compared to those with private insurance, as well as comparing by rural and urban geography, race and ethnicity. The study found rates of severe negative maternal health outcomes were greater for Medicaid-funded births compared to privately-insured births for both rural and urban residents and for all race and ethnicities, among other findings.

 Data and Innovation 

Florida Atlantic University: (6/29) - Researchers at Florida Atlantic University looked at data transparency and equity as seen by state variations in the comprehensiveness of their reporting of health metrics and variations with respect to data disaggregation of race and ethnicity metrics. Results suggested that legislatures, rather than governors, are important institutional actors and that a conservative ideology signal and socio-economic factors help predict data reporting and transparency practices. These findings suggest that there is a critical need for standardized data collection protocols, the collection of comprehensive race and ethnicity data, and analyses examining data transparency and reductions in information asymmetries as a pandemic response tool.

Health Leaders: (6/29) - CHRISTUS Health is using a data analytics platform to survey staff and patients in Texas, Louisiana, New Mexico, and Arkansas as part of a CMS-mandated community health needs assessment conducted every three years. Survey results are used to identify underserved communities and the barriers/challenges that make them underserved, and drive programs aimed at improving access and outcomes.

HIT Consultant: (6/28) - Through data measurement and community partnership, health plans can make a powerful difference in reducing health inequities to improve their members’ health. This article outlines four considerations for health plans on ways to become “data connectors” for health equity.

Governing: (6/27) - A new survey from Ernst & Young LLP found that data strategies and technology platforms are top priorities of public health officials as a response to lessons learned during the pandemic. Vulnerabilities exposed due to an uneven patchwork of technology capabilities in public health has led to opportunities to reconsider both technology infrastructure and the nature of information that is collected, including incorporating metrics in public health data systems that reflect social determinants of health.

 New Research and Reports

Fierce Healthcare: (7/6) - A new study found that Contra Costa Health Services, an integrated county health system that spent more than $22 million on a social needs case management program for its adult Medicaid patients, achieved significant reductions in hospital admissions and a minor dip in emergency department visits through the program. However, although social needs case management programs may reduce health care use, these savings may not cover full program costs given this reduced utilization translated to about $3.4 million in cost savings.

JAMA Cardiology: (7/6) - Medical literature does not often have adequately defined differences in disease burden and health outcomes as a function of race and ethnicity, and many of those differences are often falsely described as biological differences in risk. These observations reflect analyses that insufficiently address social factors and misrepresent the importance of self-identified race and ethnicity in medical research, which this study examines.

JAMA Cardiology: (7/6) - In-hospital risk of mortality for patients admitted with acute health failure varies considerably with consistently lower risk among self-described Black patients, partially resulting in multiple risk scores with race as a covariate that assigns lower risk for Black individuals. Models that use race as a covariate and are not carefully developed may have unintended results. This study examines machine learning and social determinants of health as an opportunity to move beyond race for inpatient risk prediction in patients with heart failure.

Chest Journal: (July 2022) - There is growing agreement that triage protocols for scarce medical resources such as ICU beds and ventilators should not exacerbate the profound disparities in health outcomes that are occurring during the COVID-19 pandemic among racial or ethnic minorities, persons with disabilities, and low-income people. This paper examines whether considering social determinants of health is ethically permissible for fair allocation of such resources during the pandemic.

JAMA Network Open: (6/29) - This article outlines findings from a recent study that highlight the importance of considering residential segregation as a key social determinant of health and an important factor in the disparities observed in police violence outcomes. The study reinforces the need to consider a broad multidisciplinary approach to addressing police violence, as well as other similarly complex public health issues, that examines evidence-based strategies spanning the socioecological spectrum from individual- to community-level interventions.

National Academy of Medicine: (6/27) - This paper aims to provide a comprehensive review of digital health tools and their promise to identify critical priorities for cooperation and collaboration among policy makers and industry leaders. Included in this is the cross-over between digital innovation and social determinants of health. For digital technology to have a meaningful effect on SDOH, information about nonmedical factors and services must be better collected and integrated into mobile apps and standardized, aggregated, and integrated into EHRs to promote trust and ensure secure and private management.

Upcoming Events

July/August

• July 12 - HRSA, “HRSA Maternal Health Webinar Series: Advancing Maternal & Infant Health.” Virtual.

• July 13 - Congressional SDOH Caucus, “Briefing: Addressing Food Insecurity and Nutrition as a Social Determinant of Health.” Virtual.

• July 14 - Bipartisan Policy Center, “National Convening to Inform the White House Conference on Hunger, Nutrition, and Health.” Virtual.

• July 19 - HHS ONC, “SDOH Information Exchange: Policy and Funding.” Virtual.

• August 9-10 - HRSA and the HHS Office of the Assistant Secretary for Health, “2022 Tri-Regional Maternal Health Conference: Community-Led Interventions in the Mississippi River Delta.” Dallas, TX.

• August 11- Modern Healthcare, “Social Determinants of Health Symposium.” Virtual.

Fall 2022

• Sept 15, Sept 27, Oct 12 - Social Interventions Research & Evaluation Network (SIREN), “SIREN 2022 National Research Meeting.” Virtual.

• Sept 21-23 - The National Center for Complex Health and Social Needs, “Putting Care at the Center 2022.” Sacramento, CA.

• September 2022 (Date TBA) - The White House, “White House Conference on Hunger, Nutrition, and Health.” Washington, D.C.

• October 2-4 - The Root Cause Coalition, “2022 National Summit on the Social Determinants of Health.” Minneapolis, MN.

• October 24-25 - March of Dimes, “Mom and Baby Action Network 2022 Summit.” Atlanta, GA.

SDoH Opportunities

July/August/Fall

• Deadline: July 8 - Centers for Disease Control and Prevention, Notice of Funding Opportunity: Closing the Gap with Social Determinants of Health Accelerator Plans
  

• Deadline: July 8 - City of Boulder’s Housing and Human Services Department, Request for Applications: Affordable Housing Technical Review Group, Community Development Advisory Committee, Health Equity Advisory Committee, and Human Services Fund Advisory Committee

• Deadline: July 11 - Health Resources and Services Administration, Request for Comments: Maternal and Child Health Bureau (MCHB) Performance Measures for Discretionary Grant Information System (DGIS), OMB No. 0915-0298—Revision.

• Deadline: July 15 - HHS Office of the Assistant Secretary for Health, Grants Notice: Promoting Equitable Access to Language Services in Health and Human Services

• Deadline: July 15 - White House Conference on Hunger, Nutrition and Health, Share Your Stories and Ideas

• Deadline: July 15 - USDA, Call for Nominations: 2025 Dietary Guidelines Advisory Committee

• Deadline: July 22 - Center for Health Care Strategies, Call for Applications: Medicaid Pathways Program, Class of 2023

• Deadline: July 28 - CMS, Grants Notice: Minority Research Grant Program (MRGP)

• Deadline: July 29 - Benefits Data Trust and Center for Health Care Strategies, Survey: SNAP Medicaid Coordination Project Survey

• Deadline: July 31 - Black Maternal Health Caucus, Request for Ideas: Momnibus 2.0 Legislative Recommendations

• Deadline: August 1 - HHS Office of the Assistant Secretary for Health, Request for Information: HHS Initiative to Strengthen Primary Health Care

• Deadline: August 8 - HRSA, Building Bridges to Better Health: A Primary Health Care Challenge

• Deadline: August 12 - HRSA, Grants Notice: Maternal and Child Health Services

• Deadline: August 15 - HHS Office of the National Coordinator for Health IT, Notice of Funding Opportunity: Leading Edge Acceleration Projects (LEAP) in Health IT

• Deadline: October 5 - National Institutes of Health, Notice of Special Interest: Stimulating Research to Understand and Address Hunger, Food and Nutrition Insecurity

Rolling Basis

• Deadline: Open - Aligning for Health, Endorse the Social Determinants Accelerator Act

• Deadline: Open - Aligning for Health, Endorse the LINC to Address Social Needs Act

• Deadline: Open - Chairman McGovern, Endorse the White House Conference on Food, Nutrition, Hunger, and Health Act

• Deadline: Open - Trust For America’s Health, Endorse the Protecting the Health of America’s Older Adults Act

• Deadline: Open - Anthem Foundation, Request for Proposals: Food as Medicine RFP

• Deadline: Open - House Committee on Rules, Request for Stories: Experiences, Research, and Solutions to Guide Committee Work in Addressing Hunger

• Deadline: Open - Robert Wood Johnson Foundation, Open Call for Proposals - Evidence for Action: Innovative Research to Advance Racial Equity

• Deadline: Open - Sepsis Alliance, Pledge for Equity, Diversity, and Inclusion In the Fight Against Antimicrobial Resistance, Sepsis and its Underlying Causes

• Deadline: Open - Arnold Ventures Advancing Medicare & Medicaid Integration initiative, Funding Opportunity: Technical Assistance to Advance Medicare and Medicaid Integration for Dual-Eligible Individuals.

• Deadline: Open - Opportunity Starts at Home, Send a Letter: Tell Congress to Enact the Bipartisan “Family Stability and Opportunity Vouchers Act.”

• Deadline: Open - Robert Wood Johnson Foundation, Evidence for Action: Investigator-Initiated Research to Build a Culture of Health.

• Deadline: Open - TFAH, Endorsement of the Improving Social Determinants of Health Act.

• Deadline: Open - American Hospital Association, Hospital Community Collaborative National Cohort Application.

• Deadline: Open - The de Beaumont Foundation and Johns Hopkins University, Stories of Alignment: Share a reflection related to the “Seven Ways Business Can Align with Public Health for Bold Action and Innovation” report