American Hospital Association: (3/29) - The American Hospital Association launched the Health Equity Roadmap, a framework to support hospitals and health systems in their efforts to become more equitable organizations and dismantle structural barriers to health. This roadmap is designed to meet hospitals and health systems where they are on their equity journey and includes customized resources and action plans, among other support tools, to guide organizations throughout the transformation process.
Unite Us: (3/29) - A new white paper by Unite Us outlines how health organizations can measurably improve health outcomes and close care gaps through whole-person and SDOH-driven interventions. The white paper outlines how to accurately measure the impact of SDOH on social care gaps and needs, identify health behaviors, outcomes, and experiences that have a direct effect on health plan performance, and design interventions that show return on investment.
findhelp: (3/25) - findhelp’s Chief Operating Officer, Jaffer Traish, penned this blog following testimony given at the Office of the National Coordinator for Health IT (ONC) Health Information Technology Advisory Committee (HITAC) March 2022 Virtual Hearing. The testimony outlines findhelp’s commitment to privacy, equity, and interoperability, as findhelp believes the future of social care is interoperable and equitable.
Trib Live: (3/25) - This week, nine people graduated from UPMC Health Plan’s Freedom House 2.0 program, an initiative that trains people from economically disadvantaged communities as emergency medical technicians and community health workers. The program is part of the UPMC Pathways to Work initiative, which is a “comprehensive approach to workforce development and job training” for those in the community who are unemployed or underemployed.
Modern Healthcare: (3/23) - As part of its goal of facilitating health equity by providing capital and support to investment outfits that emphasize personalized health care startups led by women and people from racial and ethnic minority communities, the American Hospital Association has invested in SteelSky Ventures. This women-led fund has a portfolio focused on maternal health, telehealth, and in-home care services and artificial intelligence tools for managing chronic health conditions.
Alliance for Better Health: (3/22) - Healthy Alliance, which is the Alliance for Better Health and its affiliates, announced the expansion of its Micro-Spend Program, which provides flexible dollars to 18 clinical and community-based organizations working with underserved communities throughout the Capital Region of New York. Through this program, Healthy Alliance allocates $1,000 per month to each participating organization to autonomously address community members’ immediate, one-time needs — such as sneakers for kids, culturally appropriate clothing, space heaters, bus passes for interviews, driver’s licenses and/or non-driver’s license IDs, and much more — on the spot.
Healthcare IT News: (3/21) - Achieving health equity requires community leaders, providers, payers, and patients working together. In this episode of HIMSSCast, Ankoor Shah from Accenture talks to community members Nicole Gyimah and Kelly Binder from Unite Us about the challenges patients can face when trying to access health care and how health systems can join community-led collaborations to help drive health equity forward.
Forbes: (3/18) - One question that findhelp has been examining over the past two years is what happens if the public health safety net breaks down. When the Affordable Care Act was passed, health care networks began looking for more ways to prevent people from going to the hospital, and began hiring social workers and care coordinators to connect members to services. findhelp leveraged this opportunity, and now works with 450 customers nationwide to help people find and connect to social services.
Systems for Action: (3/16) - As part of the Systems for Action Research-in-Progress Webinar Series, this webinar introduced a new study investigating the impact of the novel Healthy Alliance independent practice association (IPA), an affiliate of the Alliance for Better Health, which was formed among community-based social services organizations (CBOs) to address social determinants of health among residents in upstate New York. The study focused specifically on the outcomes experienced by racial and ethnic minority populations and also examined the roles played by CBOs led by Black, Indigenous, Latino and other persons of color.
Feed Hungry Veterans Act: (3/29) - Reps. Hayes (D-CT), Scott (D-VA), and Del. Radewagen (R-AS) introduced the Feed Hungry Veterans Act (H.R. 7272), which would expand the eligibility of disabled veterans to receive supplemental nutrition assistance program (SNAP) benefits and ensure they do not face barriers because of work requirements. A recent study estimated that food insecurity was 22.5 percent higher among disabled working-age veterans than the average for all working age veterans.
Homes for All Act: (3/21) - Rep. Omar (D-MN) and nine cosponsors introduced the Homes for All Act of 2021 (H.R. 7191), which would establish new units of public housing and private market affordable housing, to provide grants to combat gentrification and neighborhood destabilization, and for other purposes.
Study Barriers to Homelessness Act: (3/17) - Reps. Garcia (D-TX), Torres (D-NY), Bonamici (D-OR), Holmes Norton (D-DC), and Green (D-TX) introduced the Study Barriers to Homelessness Act (H.R. 7123), which would require the Government Accountability Office to conduct a study to identify barriers to reducing homelessness by providing housing assistance under the Public Housing and Housing Choice Voucher programs.
To view a full list of the legislation we are tracking around social determinants of health, health equity/disparities, and maternal health, click here.
CMS: (3/31) - CMS issued a proposed rule to update Medicare payment policies and rates under the Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) and the IRF Quality Reporting Program (QRP) for fiscal year 2023. Included in the proposed rule is a request for information (RFI) on overarching principles for measuring equity and health care quality disparities across CMS quality programs. The RFI requests feedback from stakeholders on the development and inclusion of health equity quality measures for the IRF QRP.
CMS: (3/31) - CMS issued a proposed rule to update Medicare payment policies and rates for the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) for fiscal year 2023. Included in this proposed rule is a request for information on considerations that CMS can consider when advancing the use of measurement and stratification as tools to address health care disparities and advance health care equity.
CMS: (3/30) - CMS issued a proposed rule that would provide routine updates to hospice based payments and the aggregate cap amount for fiscal year 2023 in accordance with existing statutory and regulatory requirements. Included in the proposed rule is a request for information on the Health Equity Initiative within the Hospice Quality Reporting Program (HQRP), describing CMS’ current assessment of health equity within hospice.
National Institutes of Health: (3/29) - A large study funded by the National Institutes of Health (NIH) found that factors beyond affordability influence disparities in health care utilization, with study results specifically finding racial and ethnic disparities in the use of pediatric acute asthma care. Black children with asthma accessed community health centers less than white children, while Latino children were more likely to visit such centers for acute, chronic, and preventive care overall. The pattern of low clinic utilization by Black children was accompanied by more frequent emergency department visits compared to the other groups.
HHS ASPE: (3/24) - The HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) released a report about HealthCare.gov Marketplace enrollment during the 2021 special enrollment period (SEP) by race and ethnicity. Overall HHS found that the 2021 SEP enrollment was 48 percent White, 28 percent Latino, 16 percent Black, five percent Asian American, Native Hawaiian, and Pacific Islander, two percent Multiracial, and one percent American Indian and Alaska Native.
Department of Housing and Urban Development: (3/24) - The U.S. Department of Housing and Urban Development (HUD) announced it is making $72 million in Youth Homelessness Demonstration Program funding available to up to 25 communities across the country. The funding will be used to develop and implement coordinated community approaches to preventing and ending youth homelessness and sharing that experience with communities across the country to mobilize them toward the same end.
HHS: (3/23) - HHS’ HealthData.gov fuels new business models, scientific advancements, and collaborative innovation by making government data open to the public, easily discoverable, and machine readable. This month, the HealthData.gov team curated datasets and resources related to health equity, asking how HHS can transform raw data into actionable insights and digital tools to bridge disparities of health, including those exacerbated by COVID, and to ensure equitable access and wellness for all. This topic will underlie the Health Equity DataJam, which is collaborating with HHS to build health equity momentum prior to the 2022 Health Datapalooza and National Health Policy Conference in April.
Fierce Healthcare: (3/21) - At the AHIP 2022 National Conference on Health Policy and Government Health Programs, CMS Innovation Center (CMMI) Director Liz Fowler noted that organizations that want to participate in value-based care models must be ready to create a health equity plan. Fowler said that requirements for creating such a plan are likely to be a permanent part of payment models moving forward, and was a requirement included in the recent launch of the ACO REACH payment model.
On March 28, 2022, President Biden released his Fiscal Year 2023 (FY23) budget request. The budget proposes $127.3 billion in discretionary and $1.7 trillion in mandatory budget authority for the Department of Health and Human Services for FY 2023. The budget demonstrates the Administration’s commitment to areas such as health equity and maternal health, among other priority areas. According to HHS, “It also advances equity through the work of the federal government and helps ensure our programs serve people of color and other marginalized populations with the opportunities promised to all Americans.”
Aligning for Health was pleased to see the inclusion of several key provisions related to SDOH, health equity, and maternal health in this budget request, including $153 million in funding to the CDC for the Social Determinants of Health program. Through this particular request, CDC will continue to expand SDOH efforts by funding another round of Social Determinant Accelerator Plans to states, tribes, territories, and/or localities to develop or enhance existing SDOH plans and sustained funding to support SDOH implementation program, evaluation, research, and data collection efforts.
For a full summary of the SDOH-related provisions included in the request, click here.
SDoH & Health Equity in the News
Business Wire: (3/31) - The College of American Pathologists (CAP) called on Congress to act on legislation to address the social determinants of health as part of National Minority Health Month in April. CAP has supported legislation to enable a better understanding of SDOH that drive health disparities, including the Social Determinants Accelerator Act which will provide grants and assistance to state, tribal, and local governments to deploy strategies addressing SDOH in their own communities.
Health Affairs: (3/31) - Moving forward and out of the COVID-19 pandemic, it is important to focus on three key ingredients of true and sustained innovation: the need to take a systems approach, engaging and acting on diverse perspectives, and leveraging public and private partnerships. This blog outlines these three facets, including how access to comprehensive and quality data for research and decision making is key to facilitating health services and outcomes research, health equity research, health interventions, and informed policy choices.
Health Affairs: (3/29) - While the Medicaid program has historically covered non-emergency medical transportation for decades, it has become increasingly clear that individuals with incomes above the Medicaid eligibility threshold face significant transportation barriers. In this episode of the Health Affairs A Health Podyssey, Seth Berkowitz from the University of North Carolina School of Medicine discusses the effect of providing a transportation benefit, which more insurers and health systems have begun to offer.
Specialty Pharmacy Continuum: (3/28) - According to the American Society of Health-System Pharmacists (ASHP) Foundation’s Pharmacy Forecast for 2022, pharmacists will have plenty of opportunities to expand their scope of practice by assessing patients for social determinants of health, among other areas. Pharmacists have had a long-standing role in public health, but only half of surveyed panelists indicated that pharmacists and pharmacy technicians will systematically screen patients for SDOH. The forecast recommended that pharmacists adopt analytical programs to assess and screen for SDOH to enhance things like medication management.
The Commonwealth Fund: (3/28) - There is broad consensus that addressing economic and social drivers of health can improve health outcomes, but standardized measures of these needs are largely absent from federal health care programs. The first ever federal measures of social drivers of health advanced through the final stages of stakeholder review for potential inclusion in the Medicare program. This blog explores this movement, while also calling for such measures to be adopted across Medicare, Medicaid and CHIP programs in an effort to standardize such measures.
Milbank Memorial Fund: (3/28) - The number of social prescribing practices, which aim to link patients with nonmedical services and supports to address their social needs, is increasing in both the US and England, although flexible payment approaches may not support their widespread adoption. This blog describes how policymakers in both countries are shifting toward developing explicit financing streams for social prescribing programs, and highlights the need for an evaluation of them to assess their success in supporting both the acceptance of these programs and their impacts.
JAMA Network: (3/24) - In order to achieve health equity, consideration must also be given to eliminating the modifiable differences in eye care that affect historically marginalized or excluded groups. In this blog, authors discuss the roles of social determinants of health and community engagement in the journey to eliminate eye care disparities.
Patient Engagement HIT: (3/24) - The American Cancer Society awarded researchers from the University of Arizona $4 million to target cancer care equity for Hispanic cancer survivors and family caregivers through its Cancer Health Equity Research Center. Through this effort, the University of Arizona will implement solution-based research to address cancer health disparities in the context of social determinants of health and reduce cancer mortality within the Hispanic community.
Governing: (3/23) - States took action throughout the pandemic to develop strategies driven by data to address social factors undermining the wellbeing of many Americans. One policy brief from researchers at the Duke-Margolis Center for Health Policy at Duke University examined how several states developed comprehensive interventions to reduce COVID-19 risks from social factors, highlighting the leadership role states can play in relieving SDOH if they leverage their authority and powers.
Healthcare Innovation: (3/22) - Major health care entities in the Philadelphia region have come together to take a new approach to health equity through the Accelerate Health Equity initiative. The goal of the initiative is to produce a tangible improvement in health inequities, and ultimately achieve measurable, positive changes in health outcomes in Philadelphia. Participants are digging into data and shaping pilot programs to address health conditions and social determinants of health.
Health Payer Intelligence: (3/22) - The National Committee for Quality Assurance (NCQA) awarded Centene Corporation with the Innovation Award for Health Equity for the company’s Health Equity Improvement Model. The award recognizes Centene’s data-driven model for being a leading-edge strategy for improving health equity and health care quality through innovative and creative solutions.
Spotlight on Maternal Health
NIHCM: (3/31) - This study found that Medicaid expansion can increase postpartum coverage and outpatient postpartum care visits among low-income individuals, while narrowing racial and ethnic disparities in coverage, contributing new findings to the association between expansion and health care utilization. Medicaid expansion was associated with a 27.8 percentage point increase in continuous postpartum coverage during the first six months post-childbirth among those covered by Medicaid, representing a 54.9 percent relative increase.
CNN: (3/27) - New York City Mayor Eric Adams announced the expansion of the Citywide Doula Initiative, which aims to provide free access to doulas for 500 families in the city’s most vulnerable neighborhoods by the end of June. Families benefiting from the program will receive three prenatal home visits from a trained doula, support during labor and delivery, and four postpartum visits. This initiative will also aim to expand the doula workforce.
Health Leaders Media: (3/23) - Amerigroup Georgia is partnering with Mom’s Meals on a pilot program that will send two nutritionally customized meals a day to pregnant members living with diabetes, in an effort to reduce delivery risks and boost clinical outcomes. The statewide program was launched in September 2021 and has delivered more than 6,000 meals to 74 members, and will now be opening up to obstetric members within the managed care program.
Center for American Progress: (3/21) - In order to improve maternal health care access and outcomes for millions of pregnant and postpartum people in the United States, the federal government must ensure that health insurance plans available through the Affordable Care Act marketplace offer robust maternity care provider networks. This paper outlines a set of standards the federal government should adopt to ensure that people are able to access a robust maternity care provider network and see improved maternal health outcomes.
AHIP: (3/18) - AHIP published a new issue brief that offers solutions to address disparities in maternal mortality by leveraging value-based care. The issue brief spotlights several real-world solutions that are working today to improve patient care, care coordination, and patient value through value-based maternity care. It also offers policy solutions to support the volume to value movement and improve maternal health care.
Data and Innovation
Forbes: (3/28) - Health plans have begun to engineer systems to collect member health data, which when combined with third party non-health care consumer data, can create a full picture of social stratification and the associated challenges. This can help plans to more easily understand the SDOH obstacles their members face in accessing care. This article explores ten factors that should be weighed when engineering such initiatives, including standardizing data elements and incentivizing data collection.
Health Affairs: (3/25) - Conducting health equity research relies on complete, accurate information about race and ethnicity, but data quality issues remain a challenge. Disaggregating the standard minimum US federal race and ethnicity categories into smaller groups may reduce missing data on questionnaires, uncover health inequities, and allow appropriate allocation of resources to meet community needs. This article summarizes opposing views that leaders and advocates should prepare to address to promote well-rounded, informed discourse as data disaggregation efforts move forward, and recommends existing resources that aim to address pushback and guide sustainable, systematic data disaggregation.
Health Affairs: (3/21) - As attention on the need to address health equity increased, two problems became apparent: there is no national standard method for capturing data on key variables needed to assess health equity; and there are no standard measures for assessing performance in improving health equity. This article suggests a typology of health equity measures to move toward a better understanding of how to measure health equity and improve health equity by reducing disparities in performance across groups.
MedCity News: (3/20) - As we work to engage underserved communities in proactive, value-based medical treatment, we need to find ways to provide more granular data that accurately and precisely reflect the communities we serve. This blog reflects on the need for better data to understand health inequities and how they progress.
Healthcare Finance News: (3/15) - According to remarks made by CMS Administrator Chiquita Brooks-LaSure at the HIMSS22 conference, data exchange is needed to understand gaps in the health care system, and CMS will soon publish a rule on enhanced data exchange as a result. She noted, “We need to build a data connected health care system. We must do this to address the inequities in our health care system.
New Research and Reports
Journal of Pediatrics: (3/29) - This study evaluated how race, ethnicity, and social determinants of health are reported and discussed in three pediatric journals. Results revealed that race, ethnicity, and SDOH data are reported without consistent categories, and their significance is not often explained in both US and international articles, indicating that researchers can be more intentional about how they collect, report, and interpret such data to better identify health disparities.
Health Payer Intelligence: (3/28) - Members of the Core Quality Measures Collaborative (CQMC) have identified multiple quality measurement gaps and recommended new digital quality measures and health equity measures. The report found seven quality measurement gaps overall, including gaps in health equity and care disparity quality measures. CQMC suggested two paths for addressing these gaps: design new health equity measures or stratify current measures to include health equity data.
Fierce Healthcare: (3/24) - A study by the Robert Wood Johnson Foundation found that Black adults were much less likely to be seen by a regular provider of their own race compared to white adults, with only 22.2 percent of Black adults surveyed stating they had a regular provider of the same race compared to 73.8 percent of white adults. Researchers called for making medical education more affordable for underrepresented groups as one solution to address this problem.
Fierce Healthcare: (3/23) - A new survey by the Physicians Foundation found that most doctors lack the time and ability to address social determinants of health for their patients. This survey, which is the first of three parts, focused on social drivers in patients and how they affect providers. It found that six in 10 providers feel they do not have adequate resources to effectively address SDOH, though nearly all want more. Top challenges included insufficient workforce to navigate patients to community resources, and lack of reimbursement to address SDOH.
Behavioral Medicine: (3/23) - This study explored geographic patterns of local-level COVID-19 vulnerability and associations with social and health determinants across Colorado. Vulnerability analyses indicated that COVID-19 rates were associated with mental health and chronic conditions along with social determinants that represent inequities in education, income, health care access, and race/ethnicity (minority percent of population), which may have disproportionately exposed some communities more than others to infection and severe health outcomes.
Behavioral Medicine: (3/23) - This paper provides an introduction to the Special Issue (SI) on COVID-19 and adverse social determinants of health, which provides theoretical and empirical context for featured articles. The study highlights existing disparities and inequities, and reviews emerging research on disparities resulting from these and the COVID-19 pandemic. General disparities and inequities resulting from the COVID-19 pandemic are briefly conceptualized through the SDOH.
Milbank Memorial Fund: (3/22) - To address income-related health inequities, we need a set of overlapping and complementary policy approaches rather than focusing on a single policy. This study explores three key “branch points” for designing policy approaches to address income-related health inequity: (1) should the needed good or service be obtained on the market? (2) do policy beneficiaries currently earn income? and (3) have policy beneficiaries earned income previously?
Patient Engagement HIT: (3/22) - A study published in Pediatrics found that Latino and Hispanic youth experiencing food insecurity experienced higher cardiometabolic risk than their food-secure counterparts. The findings showed that high-density lipoprotein cholesterol (HDL-C) levels were worse for youth in the lowest household and child food security categories than youth with high food security. Additionally, low and very low child food security was also linked to greater fasting plasma glucose (FG), triglycerides (TGs), and metabolic syndrome.
Milbank Memorial Fund: (3/22) - Prompted by stories of “patient dumping,” California enacted Senate Bill 1152, which mandates that hospitals offer patients experiencing homelessness a set of resources at discharge to ensure safety and prevent dumping. This study evaluated interventions to meet the requirements of this law across three emergency departments in Los Angeles County. It found that, despite operationalizing universal screening for homelessness, there was poor compliance with the law, and multiple barriers to implementation were identified.
Patient Engagement HIT: (3/18) - A new study published in Mayo Clinic Proceedings found that social deprivation and social determinants of health can explain nearly 40 percent of the geographic disparities in cardiovascular mortality rates. The assessment showed that areas with higher social deprivation index (SVI) and area deprivation index (ADI) had a higher occurrence of CVD mortality, likely because of the dearth of public and social goods that help individuals achieve and maintain health.
Patient Engagement HIT: (3/17) - An analysis from the Lown Institute found that 50 percent of hospitals in the US do not serve the patient populations that reflect the demographics of their communities, meaning that hospitals disproportionately serve a White patient population than which reflects community demographics. This trend is likely driven by elective care, with 70 percent of hospitals having worse racial inclusivity for elective procedures than for general services overall.
Health Affairs: (March 2022) - The impact of non-emergency medical transportation (NEMT) benefits on health care use and costs remains understudied. This study evaluated NEMT benefits offered to members of the UNC Health Alliance ACO. Participation was associated with a greater number of per person per year outpatient visits (9.2) and higher outpatient spending ($4,420) than in a comparison group. Participants were highly satisfied with the program, reporting that it eased financial burdens and made them feel safer, more empowered, and better able to take control of their health.
MACPAC: (March 2022) - The Medicaid and CHIP Payment and Access Commission (MACPAC) released an issue brief that describes federal data standards for capturing information on race and ethnicity and federal requirements for monitoring disparities in Medicaid. The brief describes the availability of such information in Medicaid administrative data, specifically the Transformed Medicaid Statistical Information System, and in federal household surveys that capture health care use and experiences of Medicaid beneficiaries, among others.