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Social Determinants Updates

August 7 to August 21, 2020

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

In this newsletter you will find updates on how the health care system is helping to meet health and social needs during the current public health emergency, 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

Health Leaders Media: (8/20) – Lyft released a case study highlighting the impact of rideshare on healthcare access and quality for Medicaid recipients based on results from Lyft’s healthcare partners, including Centene.

AHIP: (8/19) – WellCare, a subsidiary of Centene, has tackled social needs during the COVID-19 pandemic by using the WellCare Community Connections Help Line to field more than 4,000 calls from Medicare members in need. Food assistance was the most requested service, followed by medication assistance and transportation.

Healthcare Innovation: (8/14) – The State of Oregon Advisory Group shares challenges in data aggregation in a roadmap for its statewide community information exchange, with Alliance for Better Health’s Senior Director of Operations Michele Horan, R.N. weighs in, and discusses how Alliance for Better Health successfully uses the Unite Us platform for its Healthy Together network to collaborate across clinical and social spheres.

PR Newswire: (8/13) – Unite Us was named to the 2020 CB Insights Digital Health 150 List of Most Innovative Health Startups for the second year in a row.

CareSource: (8/11) – CareSource announced it is committing $50 million in investments in affordable housing projects across the country and is now actively searching for partners to champion this commitment.

Webinar 8/26
Addressing Health and Social Needs through Value-Based Care

Aligning for Health is pleased to host a webinar on August 26th at 2 pm on the intersection of health and social needs through value-based care. During this webinar, you will hear from leading health care organizations about how they are designing and leveraging value-based care arrangements to better address health and social needs among beneficiaries.


SDoH in the News

Forbes: (8/19) –COVID-19 is bound to have an impact on population health, spurring greater involvement of healthcare organizations in housing and community development efforts, and in pursuing value-based care.

Rep. Don Beyer(8/19) – Reps. Don Beyer (D-VA), Lucille Roybal-Allard (D-CA), Terri Sewell (D-AL), and Debbie Dingell (D-MI) introduced the Addressing COVID-19 Health Disparities Act, which would direct the Agency for Healthcare Research and Quality to look into the coronavirus healthcare response, including analyzing telehealth, supply chain, and health care delivery, and focus on factors contributing to and strategies to mitigate racial and ethnic disparities. 

CMS: (8/19) – CMS issued a joint informational bulleting with Department of Housing and Urban Development, Department of Agriculture, Administration for Community Living, CDC and Health Resources and Services Administration (HRSA) providing information on existing federal resources available to help improve health and housing outcomes for older adults and those with disabilities in rural America.

Governing: (8/19) – Massachusetts Governor Charlie Baker announced $3.3 million in grants to address food insecurities caused by the coronavirus pandemic, including through technology investments to help producers distribute food.

Health Leaders Media: (8/18) – ProMedica’s president of social determinants of health shares strategies for making direct investments to help combat social needs in the community, like growing the evidence base, understanding market needs and investing, and measuring results to ensure continued funding.

Health Leaders Media: (8/18) –Healthcare organizations should build partnerships with community-based organizations that are already meeting social needs rather than build their own programs, as social determinants of health partnerships are built on trust.

Fortune: (8/13) – Hospitals are increasingly acting to reduce racial and socioeconomic disparities but to further incentivize their commitment to community health and equity, they should embed measures related to health disparities into hospital performance evaluations. Doing so will help hospitals to learn from other innovative hospitals and adapt their models to improve care for their communities.

Health Affairs: (8/12) – As growing consensus supports the cross-sector alignment of health care, public health, and social service systems, Contra Costa County in California uses an innovative model to wrap together health care and social services, providing essential tools for community resilience in the face of COVID-19 and other disasters.

Patient Engagement HIT: (8/10) – Health disparities and health equity are two phrases that have often been used interchangeably recently, but health disparities refer to the differences in outcomes or disease burden between disparate groups, and lack of health equity is what caused those differences.

KTUL: (8/8) – The city of Tulsa, Oklahoma has launched the Affordable Housing Trust Fund, which is a citywide fund that will be used for loans, grants, developer incentives, rental assistance, and landlord incentives as well as helping residents’ access more affordable and workforce housing.

Better Care Playbook: (7/27) – A blog post from Better Care Playbook explores how aging and disability community-based organizations can offer services in a financially sustainable way, highlighting one CBO and its contracting relationship with a Medicare Advantage plan.

Endorse the Social Determinants Accelerator Act

Please consider filling out the form below to add your organization to the list of organizations in support of the Social Determinants Accelerator Act. Click here to see the list of organizations that have already endorsed SDAA:

Sign On

New Research and Reports

SIREN: (8/20) – This issue brief updates and summarizes the results of a published systematic review of peer-reviewed studies of food insecurity-related interventions in the context of health care delivery settings to help inform health sector food insecurity efforts.

Journal of Health Management & Practice: (8/19) – This study examined whether communities surrounding children’s hospitals are unique with regard to social needs and categorized how children’s hospitals are addressing social needs in their IRS-mandated community benefit work. The study found that children’s hospitals serve communities with greater social needs than average and are more likely to adopt interventions that address broader population health.

CDC: (8/19) – This resource rounds up research by CDC authors on a range of social determinants of health topics, expanding the scientific evidence that will help build the pathway to health equity.

Milbank Memorial Fund: (8/18) –This article provides a review of the opioid literature to propose a novel framework designed to foreground social determinants more directly in the understanding of the opioid national emergency.

Erie News Now: (8/17) – The Pennsylvania COVID-19 Task Force released a report on health disparities in the state, highlighting disparities associated with the social determinants of health and identifying 57 recommendations seeking to tackle disparities in Pennsylvania’s marginalized communities.

SIREN: (8/12) – In this cross-sectional study, researchers recruited participants from a sample of adult caregivers with pediatric patients to complete a validated, two-question screen for food security, and if positive, caregivers were given a direct referral to a partnered community food resource. Of those who screened positive, 54.9 percent opted to receive a direct-referral via phone call to a food resource agency, 31 percent were no longer interested, 10 percent were signed up for SNAP, and 59 percent were referred to local food pantries.

Milbank Memorial Fund: (8/12) – This case study on supporting meaningful engagement through community advisory councils examines what has made them and the resulting consumer engagement so successful.

Medical-Legal Partnership: (8/11) – This issue brief provides examples of how health centers in Iowa, Montana and Texas are leveraging the EHR to complement their screening for social needs as well as to increase their capacity to delivery targeted medical-legal partnership related interventions.

eHIDC: (8/10) – This report outlines collaborative initiatives currently deployed by pharmaceutical manufacturers and payers to address social determinants of health during COVID.

CDC: (8/7) – A report published by the CDC found that Black and Hispanic children are disproportionately impacted by COVID-19 with higher case rates, hospitalizations and virus-related complications, reinforcing the effect of race on health outcomes and how COVID-19 has exacerbated these disparities.

Milbank Memorial Fund: (8/5) – New research published in the Milbank Quarterly examined how changes in state policy environments contributed to US life expectancy trends from 1970 to 2014, with this article summarizing the results of the study and highlighting potential opportunities for states to improve life expectancy.

N4A: (August) – N4A has released the National Survey on Area Agencies on Aging 2020 Report and Toolkit, which tracks and documents key trends and issues facing AAAs and provides insights into how they are adapting to meet the needs of older adults in their communities.

SIREN: (August) – This study examined the perspectives, resources, role, and services provided by CBOs in response to the integration of health and social services, finding that failing to build a strong cross-sector screening and referral infrastructure that integrate health and social services could undermine the goal of improving population health through clinical and social are integration.

Healthify: (August) – Healthify released an issue brief laying a framework for quantifying return-on-investment associated with SDOH interventions and how to continually track the impacts of CBO’s social need interventions, as well as how this data fits into the steps of building an integrated care network.

SIREN: (August) – Assessing the impact of a fruit and vegetable prescription program in young Navajo children, researchers found that the proportion of participant households reporting food insecurity significantly decreased from 82 percent to 65 percent and of the number of children classified as overweight or obese at the baseline, 38 percent achieved a healthy BMI z score at program completion.

Journal of Public Health Management & Practice: (September/October Volume) –This study found that Housing First Programs in the US and Canada decreased homelessness by 88 percent and improved housing stability by 41 percent. For patients living with HIV, Housing First Programs reduced homelessness by 37 percent, viral load by 22 percent, depression by 13 percent, emergency departments use by 41 percent, hospitalization by 36 percent, and mortality by 37 percent.

Healthy People 2030

This week, HHS released Healthy People 2030, a plan to advance national disease prevention and health promotion objectives for the next decade, including setting 10-year targets for objectives related to  social  determinants of health for  the first time.

 Data Collection and Innovation

EHR Intelligence: (8/17) – Healthix is one of the largest public health information exchanges in the country, but the New York-based exchange used a coordinated approach to improve the health outcomes of individuals without stable housing by partnering with a social services network.

Health It Analytics: (8/13) – As the health care industry continues its quest to provide holistic, comprehensive and cost-effective care to patients, big data and analytics tools can help providers meet the clinical and social needs of the patients they serve, paving the way for improved population health management.

Fierce Healthcare: (8/10) – Social factors in clinical data faces two critical barriers to being harnessed and used at scale. The first is data fragmentation, as healthcare documents are generated and stored in siloed systems. The second is searchability, as being unable to search for and extract insights from healthcare documents at scale leaves centralized patient records providing little value.

Aithority: (8/10) – Healthify has partnered with Algorex Health Technologies to offer social determinants of health predictive analytics to health plans and provider organizations to better understand and proactively address the social needs of members and patients that can impact overall health outcomes.

HHS Roundtable on Using Social Determinants of Health (SDOH) Data to Fight COVID-19

HHS and CODE held a webinar on August 12 on using SDOH data to fight COVID-19, identify immediate actions they can take to better leverage SDOH data to mitigate COVID-19, especially in vulnerable communities, and support healthcare resilience during and after the pandemic.

HHS and CODE encourage stakeholders to visit the website to crowd share stories, post ideas and collaborate with others on SDOH approaches to addressing the pandemic. HHS and CODE  also released an issue brief on using SDOH data to fight COVID-19 and support recovery efforts.  

HHS/CODE Website

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