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Social Determinants Updates

October 30 to November 13, 2020

Welcome to Aligning for Health's Social Determinants Updates newsletter.

In this newsletter, you will find updates on how the 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.

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Member News

Signify Health: (11/12) – A partnership between the Iowa Department of Public Health and AFH member Signify Health for the Title V Program to improve outcomes and access to care for Iowa mothers and their children reached the milestone of performing its 7 millionth social determinants of health activity on behalf of more than 835,000 Iowa residents. Within three years, the Iowa Department of Public Health increased the number of women with Medicaid receiving regular obstetrical care from 67 percent to 97 percent by connecting 26 public health agencies in all 99 counties with Signify Health’s technology platform.

HIT Consultant: (11/11) – AFH members Signify Health, Solera, and Unite Us are featured in the latest Chilmark Research report examining new approaches and tools for utilizing community resources that can address social determinants of health and give providers the ability to extend care beyond clinics and connect patients with resources to address social needs.

American Hospital Association: (11/6) – A new brief from AFH member American Hospital Association describes how hospitals and health systems can partner with legal organizations or attorneys to meet patients’ social needs and improve community health.

American Hospital Association: (11/6) – CEO of AFH member American Hospital Association Rick Pollack wrote a perspective piece on uniting to advance health in America, noting that there has been an increased awareness of and emphasis on the social determinants of health for hospitals and health systems going forward.

AHIP: (November 2020) – In this issue brief, AFH member Centene is featured for its work to address social determinants of health by its recent partnership with Samsung to expand access to telehealth for individuals living in rural and underserved communities and the Medicaid Telehealth Partnership with the National Association of Community Health Centers to support community health centers’ ability to provide telehealth solutions for health care needs created by the COVID-19 crisis.

NORC: (November 2020) – Karin VanZant, Vice President of Integrated Community Partnerships at AFH member CareSource is featured in this NORC Spotlight Series discussing the racial and ethnic disparities in health care exposed by COVID-19 and methods to advance social determinants of health initiatives among Medicaid MCOs.

SDoH in the News

Milbank Memorial Fund: (11/12) – Improving housing has been used as a strategy to improve people’s lives and health outcomes. However, evidence supporting the use of housing interventions to improve specific dimensions of health is surprisingly weak, likely due to the fact that housing interventions address multifaceted problems and are likely to impact several aspects of well-being. This article explores data around this topic in further detail.

Healthcare Business Insights: (11/10) – Health care organizations have started to take a whole-person approach to care to address social needs, especially in the wake of COVID-19. HBI analyzed the types of needs social media users posted about throughout the pandemic, including food insecurity and housing concerns and discussed approaches hospitals can take to better address social needs.

PR Newswire: (11/10) – As part of its $600 million commitment to address racial and health inequities, CVS Health announced its plan to invest $8.7 million to build 116 units of affordable housing and expand its no-cost preventive health screening program in Orlando.

Center for Health Care Strategies: (11/9) – To address declining childhood immunization rates during COVID-19, the State of Rhode Island relied on cross-sector partnerships to accelerate its response. The state is a participant in the Aligning Early Childhood and Medicaid which is working to create greater alignment between Medicaid and early childhood services to meet the needs of children and their families.

Modern Healthcare: (11/5) – This op-ed discusses how COVID-19 has placed a spotlight on how racial discrimination factors into social determinants of health, and argues the importance of addressing and ensuring equal health outcomes for all in the United States.

NEJM: (11/5) – Investing in community health workers and community-based organizations can help address the social determinants of health that disproportionately affect low-income, minority populations that have been magnified during the COVID-19 crisis. These workers can help improve material conditions, facilitate access to care, and provide psychosocial support.

Healthify: (11/5) – Medicaid programs across the country have played a significant role in bringing payers, providers, and other stakeholders together to address social determinants of health through new initiatives. Section 1115 waivers are a critical tool for states looking to use SDOH data to improve health outcomes for the Medicaid population.

Managed Health Care Connect: (11/5) – COVID-19 has exacerbated existing social determinants of health, with some in the industry terming a new phrase of ‘COVID Determinants of Health’ (CDoH), which serve to exacerbate health outcomes and risks associated with COVID-19. This article discusses trends in CDoH and three suggested strategies to address them moving forward.

Health Affairs: (11/4) – COVID-19 has exposed the structural racism that exists in policies, ideologies, and systems including the health care system. This article proposes an anti-racist approach to medical care that emphasizes recognizing racism’s historical roots, identifying racism within the medical system, and dismantling it to challenge enduring racial health disparities.

RAC Monitor: (11/4) – Medline recently awarded $250,000 in grants to 13 organizations working to address community health and social determinants of health. The focus of these organizations span from addressing food insecurity to health quality and access.

Health Payer Intelligence: (11/3) – COVID-19 has further revealed the impact of social determinants of health for communities across the country. Medicaid programs have responded to address social needs with innovative solutions that can help guide payer industry efforts in this area.

The Business Journal: (11/3) – In 2019, Ohio Governor DeWine expanded the Home Visitation initiative, which provides pregnant women with free resources and services intended to help address social needs for low-income individuals in the state. This initiative has been critical to address infant mortality within the Medicaid program, and has resulted in fewer preterm births and shorter stays in neonatal ICUs.

NJ Spotlight News: (11/3) – NJ Spotlight News convened a panel of clinical and policy experts to discuss maternal health outcomes in the state. Panelists highlighted the Nurture NJ campaign, which has helped reveal significant racial gaps in maternal health outcomes in New Jersey, and discussed how to ensure more equal access to maternal health care and family planning.

Forbes: (10/31) – Low health literacy has consistently been linked to poor health outcomes, but it has largely been left out of the discussion around social drivers of health. This article explores why health literacy is not prioritized in social needs interventions.

Healthcare IT News: (10/30) – In a recent interview, chair of the HIMSS Chapter Advocacy Taskforce Ian Slade said there is a large disparity in health literacy affecting how individuals navigate the health care system. This interview outlines the Chapter’s priorities related to social determinants and health equity.

 Data Collection and Innovation

JAMIA: (11/7) – This systematic review identifies and analyzes literature to examine the integration of SDOH domains into electronic health records, their impact on risk prediction, and the specific outcomes and SDOH domains that have been tracked. The literature provides evidence that integrating individual-level SDOH into EHRs can assist in risk assessment and predicting health care utilization and outcomes.

RTI International: (11/5) – While using health IT and data to connect patients with community services and share SDOH information with community service providers is important, it comes with many challenges. Value-based care provides incentives for providers to address SDOH and integrate health and human services information, but accomplishing this will require strategies to extend health IT infrastructure to community-based organizations and to capture and integrate SDOH data in EHRs.

Patient Engagement HIT: (11/4) – Conducting individualized screenings for social determinants of health are reported to provide more granular data about patient needs for social service interventions compared to relying on community-level data, according to a recent study by JAMA Network Open.

NIH: (10/19) – The NIH released a notice announcing a major data-harmonization effort at the National Institute on Minority Health and Health Disparities (NIMHD) to address SDOH and to encourage researchers to use new data collection tools for this effort. Through the use of such SDOH measures and common data elements, researchers will be able to share, compare, and integrate data across studies.

New Research and Reports

Health Affairs: (November 2020) – In 2015, Indiana used a 1115 Medicaid waiver to expand Medicaid eligibility and improve interagency coordination to expedite coverage for justice-involved adults. Such efforts led to a 29 percent increase in coverage for this population and 14 percent increase in coverage effective within seven days of release, suggesting that interagency coordination can increase timely access to Medicaid coverage.

CMS: (November 2020) – CMS released its Long-Term Services and Supports Rebalancing Toolkit, which is the latest in a series of efforts to promote high quality, person-centered home and community-based services (HCBS) to help transition older adults and individuals with disabilities from institutional care to their homes. The toolkit is designed to support state Medicaid agencies in their efforts to expand and enhance HCBS.

Healio: (11/12) – A new review from the American Diabetes Association revealed that social determinants of health interventions are essential for achieving health equity for patients with diabetes and provides recommendations for designing effective interventions that target social needs.

Patient Engagement HIT: (11/9) – A recent report featured in JAMA Network Open revealed that a NYC policy to ban smoking in public housing authorities yielded little change to air quality in the first year since the policy was implemented. The policy was originally intended to improve air and housing quality to improve health outcomes. These findings have underscored the need for including materials explaining rules and enforcement of the air quality housing policy to yield positive changes in SDOH.

Patient Engagement HIT (11/5) – Doctors continue to identify social risk factors as critical to patient health outcomes. The Physicians Foundation 2020 Survey of America’s Physicians revealed that nearly three-quarters of providers agreed that social determinants will put the biggest strain on the health care industry in 2021, and 44 percent said addressing health equity would be key to ensuring access to care.

JAMA Network: (11/5) – A new blog in JAMA highlights the importance of supporting community health centers, improving interracial communication in healthcare, and strengthening the caregiving workforce for seniors to achieve health equity during the COVID-19 pandemic.

Patient Engagement HIT: (11/3) – A recent study in Health Affairs confirmed data around the massive racial health disparities observed during the COVID-19 crisis. Black and Hispanic patients are twice as likely to be hospitalized from the virus, and Hispanic patients are twice as likely to die from it compared to White patients. Structural racism is thought to be an underlying driver influencing these health disparities.

NASHP: (11/2) – NASHP conducted a 50-state review of Medicaid dental and medical managed care contracts, requests for proposals, and other documents to identify how states address social determinants of oral health. This map highlights key findings and potential opportunities for states to leverage medical contract SDOH language in dental contacts to support oral and overall health.

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