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.
Medium: (2/13) - In the latest “Technology Making an Important Positive Social Impact” interview series, Dave Philistin, CEO of Candor, interviewed Unite Us co-founder Taylor Justice on the work Unite Us is doing to create meaningful and sustainable cross-sector partnerships with leaders in government, health care, philanthropy, business and community. Justice talks about how Unite Us has built an end-to-end solution for social care at scale to address existing siloes between the health care and social services sectors.
Blue Shield of California: (2/9) - Blue Shield of California, a health plan of the Blue Cross Blue Shield Association, announced an innovative community health-focused initiative that incorporates a high-tech, high-touch approach along with collaboration with community-based organizations to help improve support, care and family-centered services for mothers, birthing people, and their babies. Blue Shield of California’s Maternal Child Health Equity initiative offers a comprehensive program to address maternal mortality, especially in underserved communities.
STAT: (2/8) - As health insurers lean more heavily on new technologies to predict which patients will miss out on care because of social determinants of health like transportation, some concerns arise around lack of standards or checks on their use that could propagate biases in health care. Social-services tech companies like Unite Us have stepped in, helping payers such as one in Michigan in leveraging social risk scores to narrow outreach for a food security program to a couple thousand needy seniors to remove barriers to health for those who need it.
American Hospital Association: (2/4) - The American Hospital Association (AHA) sent a letter to Senate HELP Committee leaders in response to the discussion draft of the PREVENT Pandemics Act. Notably, AHA outlined its support for Section 201 of the draft to support efforts, including grants and studies, to address social determinants of health in order to reduce health disparities and improve health outcomes.
CareSource: (2/2) - CareSource made a $1 million grant to the Coalition on Homelessness and Housing in Ohio to redistribute the funding to dozens of local agencies that were facing the dual crises of COVID-19 and homelessness. The goal of the grant was to support community organizations struggling to continue providing shelter and housing services due to increased need stemming from the economic recession resulting from the pandemic.
American Hospital Association: (February 2022) - The American Hospital Association released its 2022 Advocacy Agenda, focusing on several areas to positively influence public policy for patients, communities, and the health care field. Among its priorities includes addressing the impact that social determinants of health have on patient outcomes by improving care coordination and expanding the tools that hospitals can use to meet these needs.
Affordable Housing Resident Services Act: (2/4) - Rep. Aguilar (D-CA) and 14 cosponsors introduced the Affordable Housing Resident Services Act (H.R. 6602), which would authorize funding of enriched resident services in federally assisted affordable housing. Specifically, the legislation creates a five-year grant program under the Department of Housing and Urban Development (HUD) to provide yearly funding to affordable housing property owners for resident supportive services, such as elderly care, financial literacy training, after school programs, and more.
Advancing Maternal Health Equity Under Medicaid Act: (2/4) - Rep. Manning (D-NC) and 19 cosponsors introduced the Advancing Maternal Health Equity Under Medicaid Act (H.R. 6612), which would provide a higher federal matching rate for increased expenditures under Medicaid for maternal health care services.
DEPICT Act: (2/3) - Reps. Eshoo (D-CA), Fitzpatrick (R-PA), and Kelly (D-IL) introduced the Diverse and Equitable Participation in Clinical Trials (DEPICT) Act (H.R. 6584), which would direct the Commissioner of Food and Drugs to amend certain regulations to increase clinical trial diversity. The bill would require enhanced data reporting on clinical trial demographics and provide resources to improve access to clinical trials.
Targeting Resources to Communities in Need Act: (2/1) - Reps. Clyburn (D-SC), Rogers (R-KY), Lee (D-CA), and Cohen (D-TN), introduced the Targeting Resources to Communities in Need Act of 2022 (H.R. 6531), which would provide an increased allocation of funding under certain programs for assistance in areas of persistent poverty. Sens. Booker (D-NJ) and Portman (R-OH) introduced companion legislation in the Senate (S. 3552).
To view a full list of the legislation we are tracking around social determinants of health, health equity/disparities, and maternal health, click here.
Aligning for Health convened a sign-on letter in response to the Senate HELP Committee discussion draft of the PREVENT Pandemics Act, bipartisan legislation focused on strengthening the nation’s public health and medical preparedness and response systems in the wake of COVID-19.
Section 201 of the PREVENT Pandemics Act discussion draft focused on addressing social determinants of health and improving health outcomes. To strengthen this section of the bill, more than 50 organizations signed on in support of this letter, asking the committee to consider including the bipartisan LINC to Address Social Needs Act (S. 509/H.R. 6072) in the final legislative text of the PREVENT Pandemics Act.
Support for Legislation Endorsed by Aligning for Health
Aligning for Health recently submitted comments in response to the PREVENT Pandemics Act, and was pleased to see other organizations also wrote in support of the discussion draft’s SDOH provision. Several organizations recommended the inclusion of other SDOH bills, such as the Social Determinants Accelerator Act (H.R. 2503/S. 3039) and the LINC to Address Social Needs Act (S. 509/H.R. 6072), in their responses to the discussion draft and in other publications over the past few weeks. To learn more about these important pieces of legislation, visit our website or read on below for news coverage:
Center for American Progress: (2/14) - In its response to last year’s request for information from the Congressional Social Determinants of Health Caucus, the Center for American Progress (CAP) outlined challenges in addressing the social and economic conditions that affect health, and actions Congress can take to improve them. Among the many recommendations made, CAP suggested several legislative actions that Congress can take immediately to help address SDOH, including passing pending legislation that has potential to improve health outcomes. Two such pieces of legislation cited included the Social Determinants Accelerator Act of 2021 (H.R. 2503/S. 2986) and the LINC to Address Social Needs Act (S. 509/H.R. 6072).
Association for Clinical Oncology: (2/4) - The Association for Clinical Oncology (ASCO) sent a letter to Senate HELP Committee leadership in response to the PREVENT Pandemics Act, applauding them for the inclusion of several sections including Section 201 to address social determinants. ASCO specifically notes its endorsement of the Social Determinants Accelerator Act (S. 2986/H.R. 2503) as a bill that would create the Social Determinants Accelerator Interagency Council tasked with distributing grants for social determinants accelerator plans, allowing communities to tackle SDOH more effectively by improving data collection and coordination of services.
Executives for Health Innovation: (2/4) - Executives for Health Innovation (EHI) wrote to the Senate HELP Committee expressing its support for the PREVENT Pandemics Act discussion draft. On Section 201, EHI writes, “EHI supports Section 201 and appreciates the Committee’s focus on addressing social determinants of health (SDOH). A key aspect of addressing SDOH is ensuring there is accurate and timely data available. To that end, EHI supports adding the LINC to Address Social Needs Act (S. 509/H.R. 6072) to this section.”
To learn more and endorse the Social Determinants Accelerator Act, click here. To learn more and endorse the LINC to Address Social Needs Act, click here.
ASPE: (2/15) - The HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) released a report synthesizing information gathered from an environmental scan and case studies to provide an overview of early implementation of expanded supplemental benefits in Medicare Advantage (MA), and its potential duplication with benefits offered by Medicaid managed care plans. Approximately 10 percent of MA plans offered expanded supplemental benefits in CY2019 and 2020, and there was more overlap with expanded primarily health-related benefits in MA organizations than with SSBCI. MA organizations also reported that expanded supplemental benefits provided a key opportunity to better target and address social determinants and long-term services and support needs for their members.
NIH: (2/11) - The National Institutes of Health (NIH) released a request for information in developing the NIH-Wide Strategic Plan for Diversity, Equity, Inclusion, and Accessibility (DEIA). Comments are due by April 3.
HHS: (2/10) - The Department of Health and Human Services (HHS) released a new report highlighting the economic impact of the American Rescue Plan and the role it played in reducing poverty. The report, which was produced by HHS ASPE, projects that economic relief efforts, such as economic impact payments, unemployment compensation and expanded unemployment compensation, and monthly Advance Child Tax Credit payments, kept 20.1 million people out of poverty. Poverty reductions were larger for groups with historically higher poverty rates, such as American Indian/Alaska Native (7.6 percent), Black non-Hispanic people (7 percent), and Hispanic people (6.9 percent).
HHS: (2/8) - HHS Secretary Xavier Becerra provided remarks at the recent Health Affairs Virtual Symposium on Racism and Health. In his remarks, Secretary Becerra noted that HHS will continue to make justice in the medical space a top priority, and will continue to prioritize equitable access to care and improving maternal health outcomes.
GAO: (2/7) - The U.S. Government Accountability Organization (GAO) released a report showing that CDC exceeded its goal to administer COVID-19 vaccines to people from racial and ethnic groups other than non-Hispanic White. However, GAO comparisons of available program vaccination and population data suggest disparities remain among certain racial and ethnic groups.
CMS: (2/4) - The Centers for Medicare and Medicaid Services (CMS) released an overview of the states’ planned activities for the American Rescue Plan Act enhanced funding to support Medicaid home- and community-based services. The most commonly proposed activities were strengthening the provider workforce, expanding beneficiary services, enhancing use of technology and telehealth, improving quality and impacting social determinants of health.
HUD: (2/4) - The US Department of Housing and Urban Development released its 2021 Annual Homeless Assessment Report Part 1 to Congress. The report found that more than 326,000 people experienced sheltered homelessness in the US on a single night in 2021, a decrease of eight percent in 2020.
SDoH & Health Equity in the News
The Kresge Foundation: (2/17) - The Health Program at the Kresge Foundation believes that communities have a sophisticated understanding of the challenges they face, and the expertise and experience to drive locally-determined solutions to improve health. The Health Program announced it is expanding its community-driven solution grant funding to support community safety and provide ongoing support to accelerate efforts related to equitable food systems, climate change, and health equity through housing.
Center for Health Care Strategies: (2/16) - The Health Care Payment Learning and Action Network (LAN) recently released guidance for equity-centered design and implementation in alternative payment models (APMs), which recommended changes to APMs to make care more accessible and equitable and to drive better health outcomes. This blog post summarizes the LAN guidance and describes practical steps for immediate action to ensure state Medicaid agencies can support health equity within payment reform efforts.
Eagle Public Relations: (2/15) - The Northeast Business Group on Health released the “Social Determinants of Health: A Guide for Employers” to help human resources and benefit leaders identify and address the health-related social needs of their employees and their families. The guide provides an overview of SDOH, and an in-depth discussion on the importance of collaboration among various entities such as health plans, hospital systems, community groups, government agencies, and tech companies.
Patient Engagement HIT: (2/11) - CVS Health announced a $12.7 million donation to address housing security and care access for underserved populations in Tennessee. These funds will help build 204 new affordable housing units in the Chestnut Hill neighborhood of Nashville.
City of New York: (2/10) - New York City Mayor Eric Adams signed two executive orders to underscore his administration’s commitment to food justice and to reducing diet-related health inequities and disease outcomes. The first executive order will task the Department of Health and Mental Hygiene and the Mayor’s Office of Food Policy with revising the City Agency Food Standard, and the second order will require that all promotional materials put out by agencies and advertisements on city property regarding food feature healthy food. Mayor Adams also announced the new Food Distribution Program procurement which will include fresh fruits and vegetables for the first time in 30 years.
mHealth Intelligence: (2/10) - Remote patient monitoring (RPM) is a key aspect of home-based care and helps enable providers to track patient outcomes and offer care outside their facilities. However, as providers ramp up RPM programs, they must also work toward ensuring access within underserved communities and overcome hurdles like reimbursement and SDOH challenges like lack of stable internet connectivity.
Cal Matters: (2/9) - Nonprofit, tribal organizations, and other community organizations are continuing to advocate in California to ensure that a $100 million health equity and racial justice fund is included in this year’s state budget, as it was left out by Governor Gavin Newsom in 2021. The groups have said they should be considered a part of the state’s public health infrastructure, given they play a crucial role in reaching underserved communities and have helped reduce the spread of COVID-19 for the communities they serve.
Forbes: (2/8) - Interventions to address health inequities require a concerted effort across multiple fronts and stakeholders. This op-ed offers four tactical actions that health care providers and business leaders can explore to support the reduction in health inequities: 1) center equity as a strategic priority; 2) partner with community-based organizations; 3) focus on whole-person care; and 4) augment clinical workflows with AI.
Health Payer Intelligence: (2/7) - Blue Cross and Blue Shield of Texas, through its Healthy Kids, Healthy Families program, launched a grant cycle for 2022-2023 that will support social determinants of health, health and wellness, and health equity initiatives through partnerships with community-based organizations. The program will focus on key areas including disease prevention and management, nutrition, physical activity, and safe environments.
Nemours Children’s Health: (2/7) - In the February edition of Current Opinion in Pediatrics, research and policy leaders from Nemours Children’s Health outlined the most effective strategies for population health improvement. They share how health systems working alongside community stakeholders and policymakers can create the healthiest generations of children by addressing social determinants of health to promote equitable health outcomes across race, ethnicity, and socioeconomic backgrounds.
Spotlight on Maternal Health
Health Day: (2/15) - A new study found that 60 percent, or higher in some states, of pregnant women have one or more complications of pregnancy, such as hypertension, diabetes, or obesity. The study also revealed geographical differences in outcomes largely due to social determinants of health such as education, Medicaid enrollment status, access to preventive care, ability to afford healthy foods, and neighborhood characteristics.
Milbank Memorial Fund: (2/8) - State-level social and economic policies that expand tax credits, increase paid parental leave, raise the minimum wage, and increase tobacco taxes have been demonstrated to reduce adverse perinatal and infant health outcomes. The findings presented in this article can help prioritize evidence-based legislated policies to improve perinatal and infant outcomes in the United States.
Data and Innovation
Milbank Memorial Fund: (2/16) - Even though Asian American and Pacific Islander (AAPI) people are a diverse group consisting of more than 50 ethnicities, their health data is often aggregated as one race. In this new blog post, Kevin H. Nguyen of Brown University explores the value of collecting and reporting on disaggregated AAPI data to better understand and address health disparities among AAPI people.
EHR Intelligence: (2/15) - A recent article published in Health Affairs found that standardized EHR documentation of disability status could help drive health equity. Disability data is often absent from EHRs, or the information may be buried in charts or documented in ways that care teams cannot easily reference it. The article called for federal stakeholders to mandate the standardized completion of this information and tie completion to hospital incentives to improve the input of disability data in the EHR.
Journal of the American Board of Family Medicine: (February 2022) - This study examined food insecurity and how the process of screening and referring patients to resources to address food insecurity are viewed by multiple stakeholders. All stakeholders surveyed recognized the impact food insecurity had on health outcomes, but perspectives varied on the value of sharing information through referrals to food assistance organizations and concerning receipt of services, including privacy concerns and that the process would require significant work without necessarily improving outcomes.
DocWire News: (2/15) - This study aimed to explore multiple social determinants of health and depression among African American adults in the US, and used cross-disciplinary mental health terminology to conduct a comprehensive search to capture studies specific to African American adults in the US. Sixty studies were included in the final sample, most of which focused on discrimination and social support. The researchers recommended that research comprehensively examine mental health risk and protective factors over the life course within populations to inform tailored health promotion and public policy interventions for improving SDOH and reducing racial and ethnic health disparities.
DocWire News: (2/15) - This study examined the influence of social determinants on COVID-19 infection in vulnerable social groups. Researchers found that SDOH such as access to drinking water and economic income influenced the infection of COVID-19, and that these specific SDOH were significant predictors of contracting the virus.
Fierce Healthcare: (2/15) - A recent Health Affairsstudy found that racial and ethnic minorities enrolled in Medicaid managed care plans reported worse experiences of care than their white counterparts with identical coverage. Researchers looked at racial and ethnic disparities in four experiences of care measures: access to needed care, access to a personal doctor, timely access to checkup or routine care, and timely access to specialty care. Racial and ethnic minorities reported significantly worse experiences of care on all four of these metrics.
American Medical Association: (2/10) - The American Medical Association, in collaboration with Health Begins, published a toolkit entitled “Racial and Health Equity: Concrete STEPS for Health Systems.” The toolkit outlines five steps to translate a health system’s commitment to racial and health equity into action.
Patient Engagement HIT: (2/7) - The latest CDC Morbidity and Mortality Weekly Report found that new diagnoses of HIV are among the most socially vulnerable. About half (52 percent) of Black people diagnosed with HIV were also in the upper quartile on the Social Vulnerability Index (SVI), with higher scores equating to greater social need. Black adults living in areas in the highest SVI quartile were 1.5 times more likely to be diagnosed with HIV than those living in the lowest SVI quartile.
Health Affairs: (2/7) - This article highlights methodological approaches that will move the health care field forward in its ability to validly measure structural racism for the purposes of achieving health equity. The authors identify three key areas that require scholarly attention to advance antiracist health policy research: historical context, geographical context, and theory-based novel quantitative and qualitative methods that capture the multifaceted and systemic properties of structural racism as well as other systems of oppression.
Health Affairs: (2/7) - Examining how spatial access to health care varies across geography is key to documenting structural inequalities in the United States. In this article and the accompanying StoryMap, Health Affairs researchers identified ZIP Code Tabulation Areas (ZCTAs) with the largest share of minoritized racial and ethnic populations and measured distances to the nearest hospital offering emergency services, trauma care, obstetrics, outpatient surgery, intensive care, and cardiac care. Patterns revealed in the study likely result from a combination of housing policies that restrict housing opportunities and federal health policies that are based on service provision rather than community need.
American Journal of Preventive Medicine: (2/7) - In 2019, data on social risk screening capability were collected from every US Federally Qualified Health Center (FQHC). The objective of this study was to describe the national rates of social risk screening capabilities across FQHCs, identify organizational predictors of screening, and assess between-state heterogeneity. The study found that 71 percent of FQHCs collected social risk data, with a between-state variation.
Health Affairs: (February 2022) - Research related to racism and health has evolved in recent decades, with a growing appreciation of the centrality of the social determinants of health, life-course approaches and structural racism, and other upstream factors as drivers of health inequities. This study concluded that there is a need to acknowledge the central role of racism in the national discourse on racial inequities in health, and paradigmatic shifts are needed to inform equity-driven policy and practice innovations that would tackle the roots of the problem of racism and dismantle health inequities.
American Public Human Services Association: (January 2022) - The American Public Human Services Association, in collaboration with the National Community Action Partnership, published a partnership playbook for community action and human services agencies. The playbook outlines ways in which Community Action and human services agencies worked together to meet the challenges of COVID-19, and how communities have leveraged opportunities to partner on approaches that improve outcomes.