Highlights

• Booker, Sewell introduce legislation to require CMMI to consider health disparities, SDOH in payment models

• HHS ASPE releases three documents focused on HHS’ strategic approach to addressing SDOH

• HRSA announces funding to support community-based doulas

• White House releases Equity Action Plans across federal agencies

• CMS announces key actions to reduce maternal mortality and morbidity

• Biden-Harris Administration announces additional actions on maternal health

Member News

Business Wire: (4/14) - Signify Health released its 2021 Quality and Social Impact Report, which offers a framework for how the company will measure its performance on key environmental, social, and corporate governance issues, in addition to health care quality measures, in alignment with its vision and values. Among Signify Health’s key accomplishments from 2021 and baseline for moving forward is managing social determinants of health through its more than 600 social care coordinators that screen individuals for social issues that affect their ability to access high quality health care.

Perishable News: (4/12) - findhelp announced a new partnership with GA Foods, a national nutrition fulfillment platform for at-risk populations. The partnership will help address food insecurity nationwide by providing an easy way for findhelp customers to order and deliver medically-tailored meals and nutritious meal kits to the people they serve.

American Hospital Association: (4/11) - In this article, American Hospital Association (AHA) Chair Wright Lassiter III talks about the gaps in maternal health care that continue to persist for Black women, the root cause of which include pre-existing conditions, structural racism, and lack of access to perinatal and obstetric services or support systems. Henry Ford Health has been laser-focused on reducing infant and maternal mortality in Detroit’s Black communities, including through the Women-Inspired Neighborhood Network: Detroit and a task force to find lasting, collaborative solutions to address high infant mortality rates.

Local 21 News: (4/11) - Advocates stress that the Black maternal health crisis is a preventable health inequity rooted in systemic racism. Expanding accessibility where social determinants of health act as a boundary is key. UPMC Lititz OBGYN Department Chair Dr. Sharee Livingston noted the importance of social determinants of health, such as living in a food desert or having transportation to and from doctor’s appointments. Dr. Livingston also noted that when biases are turned into discriminatory practices, this is a problem.

Blue Cross Blue Shield Association: (4/11) - Blue Cross Blue Shield Association identified 10 tangible steps organizations can adopt to improve maternal health and make a measurable difference in health disparities. This blog post outlines those steps and calls upon leaders in the public and private sectors to adopt them.

Blue Cross Blue Shield Association: (4/8) - This blog reflects on the work Blue Cross Blue Shield Association has done over the past year to achieve its goal of reducing racial disparities in maternal health by 50 percent in five years. Learnings include that data is critical to measure impact, postpartum care is vital maternal care, and maternal care must be culturally conscious and competent.

MedCity News: (4/1) - In this article, Halima Ahmadi-Montecalvo, Senior Director of Research and Evaluation at Unite Us, discusses the health crisis facing Black communities as a result of structural racism, racial disparities and biases that have persisted over time. She discusses several strategies to consider as we work to advance health equity and address poor health outcomes rooted in structural racism, such as collecting data to define the problem and the importance of re-earning trust in the health care system.

Signify Health: (April 2022) - Signify Health recently held a briefing on innovative solutions to address social determinants of health for Medicare and Medicaid beneficiaries. Reps. Bustos (D-IL) and Bilirakis (R-FL) provided opening remarks and discussed how they are working to meet the SDOH needs of their constituents, and leading experts from the private sector shared their SDOH insight and experience.

Legislative Updates

John Lewis Equality in Medicare and Medicaid Treatment Act: (4/13) - Senator Booker (D-NJ) and Rep. Sewell (D-AL) introduced the John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act (S. 4067), which would require the CMS Innovation Center (CMMI) to work with experts to consider health disparities when developing payment models. The bill would direct CMMI to consider a model’s impact on access to care for people of color, women, and people in rural areas, and to create a Social Determinants of Health Model that focuses on health conditions of those dually eligible for Medicare and Medicaid, maternal mortality, and behavioral health.

Ms. Magazine: (4/11) - Rep. Gwen Moore (D-WI) penned an op-ed on the maternal mortality crisis that disproportionately impacts women of color in the United States. She speaks about her own experience in childbirth as a Black woman, and highlights the need for legislation like her Mamas First Act to expand access to trusted perinatal workers like doulas and midwives to improve outcomes.

Rep. Alma Adams: (4/11) - Reps. Adams (D-NC) and Underwood (D-IL) and Sen. Booker (D-NJ) introduced companion resolutions recognizing Black Maternal Health Week to bring national attention to the maternal health crisis in the US, and to urge the importance of reducing maternal mortality and morbidity among Black women and birthing persons. The House resolution has 94 original cosponsors and the Senate resolution has 16 original cosponsors.

Mamas First Act: (4/7) - Reps. Moore (D-WI), Underwood (D-IL), Adams (D-NC), Dingell (D-MI), and Pressley (D-MA) introduced the Mamas First Act (H.R. 7475), which would provide coverage under the Medicaid program for services provided by doulas and midwives.

Rep. Cheri Bustos: (4/6) - During a recent hearing on social and emotional learning in K-12 education, Rep. Cheri Bustos (D-IL) highlighted the need to address social determinants of health. She commented on the need to address the SDOH impacting student’s mental and physical well-being in order to take a whole-child approach.

Data Mapping to Save Moms’ Lives Act: (4/5) - The House passed the Data Mapping to Save Moms’ Lives Act (H.R. 1218) by a vote of 409-11. The bill requires the Federal Communications Commission to incorporate data on maternal health outcomes into its broadband health maps. The bill now heads to the Senate for consideration.

Improving Access to Health Care in Rural and Underserved Areas Act: (4/4) - Rep. Lee (D-NV), Joyce (R-OH), O’Halleran (D-AZ), and Fitzpatrick (R-PA) introduced the Improving Access to Health Care in Rural and Underserved Areas Act (H.R.7383), which would establish a program ensuring access to accredited continuing medical education for primary care physicians and other health care providers at FQHCs and rural health clinics, to provide training and clinical support for primary care providers to practice at their full scope and improve access to care for patients in underserved areas. One Pager

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

White House: (4/14) - The Biden-Harris Administration developed Equity Action Plans across federal agencies to address and achieve equity for all Americans. These Equity Action Plans are required to include accountability mechanisms and to identify success metrics and key milestones toward progress. HHS will use its Equity Action Plan to advance equity through strategies that build data capacity, expand stakeholder engagement, and increase the nation’s understanding of the root causes of inequities. Remarks from HHS can be found here. Key actions include: Responding to the nation’s maternal mortality crisis, resourcing and implementing equity assessments across HHS’ major policies and programs, and continuing to build on programs launched in 2021, such as the CMS Health Equity Inventory and Minority Health Social Vulnerability Index.

White House: (4/13) - Vice President Kamala Harris convened a meeting with Cabinet Secretaries and agency leaders to discuss the Administration’s whole-of-government approach to addressing maternal mortality and morbidity. Ahead of this meeting, the Administration announced several new actions to address maternal health and combat inequities, including expanding the extension of one-year postpartum coverage in Medicaid and CHIP to 11 states and DC, funding for State Maternal Health Innovation and Implementation Program, and developing maternal health best practices.

HHS: (4/13) - HHS announced approximately $16 million to strengthen Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Programs through seven awards supporting eight states. These awards will advance data and technology innovations to support positive maternal and child health outcomes in states and communities, and focus on addressing health disparities.

CMS: (4/13) - CMS released additional details about the proposed “Birthing Friendly” hospital designation intended to drive improvements in maternal health outcomes. The new designation would assist consumers in choosing hospitals that have demonstrated commitment to maternal health and the delivery of high-quality maternity care.

White House: (4/8) - President Biden released a proclamation on Black Maternal Health Week, 2022, renewing the Administration’s commitment to addressing the crisis of Black maternal mortality and morbidity across the country. Leaders across the Administration, including HHS Secretary Becerra, also released statements in recognition of Black Maternal Health Week and releasing policies and programs to address the maternal health crisis.

HHS: (4/8) - HHS issued a request for information (RFI) for further input for the development of the 2022 Environmental Justice Strategy and Implementation Plan. HHS would like to identify priority actions and strategies to best address environmental injustices and health inequities for people of color, disadvantaged, vulnerable, low-income, marginalized, and indigenous populations. Comments are due by May 19, 2022.

CMS: (4/4) - CMS released the Calendar Year (CY) 2023 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (the Rate Announcement). CMS acknowledged the many comments it received on several RFIs included in the Advance Notice, including those related to driving health equity and developing a health equity index. The majority of commenters supported including a health equity index in the Star Ratings for Medicare Advantage, but CMS would undergo additional rulemaking to adopt such an index. CMS will take these comments into consideration as it continues work to advance health equity.

HHS: (4/1) - HHS announced the availability of $4.5 million for hiring, training, certifying, and compensating community-based doulas in areas with high rates of adverse maternal and infant health outcomes. This funding, provided through HRSA’s Healthy Start Initiative, will increase the total number of Healthy Start doula programs from 25 to 50 nationwide.

SDoH & Health Equity in the News

Commonwealth Fund: (4/13) - State-based health insurance marketplaces have played a vital role in reducing racial and ethnic disparities in coverage, but considerably more work is needed to ensure everyone enrolled in private plans have equitable access to the services needed to attain good health. This article looked at four state marketplace approaches to health equity, finding a need for more data to understand the people served and to design effective health equity strategies.

Healthcare Finance News: (4/11) - UnitedHealth Group is investing $100 million in affordable housing initiatives with a focus on the Health and Housing Fund, a partnership with Stewards of Affordable Housing for the Future and National Affordable Housing Trust. The investment will add about 1,000 homes for those struggling with housing insecurity.

The Chicago Crusader: (4/11) - The Illinois Department of Health and Family Services (HFS) will provide nearly $66 million in funding for the Medicaid Innovation Collaborative, which will address social factors that impact health such as housing and food insecurity. This initiative will engage community-based organizations to address social determinants of health needs throughout the state.

Health Leaders: (4/7) - Aetna partnered with Papa to address loneliness among Aetna members through a new brand of caregiving, involving personalized care and enhanced data collection. The partnership has led to decreased loneliness for 86 percent of its Florida members, with comparable results in new markets. Such partnerships help Medicare Advantage plans address social determinants of health.

Patient Engagement HIT: (4/7) - NYU Langone Health launched a community-based care program helping low-income immigrant children gain access to hearing loss screenings. The Hearing Loss Awareness and Screening Program for Low-Income Immigrant Families aims to address hearing loss needs and bring screenings to community-based settings to address community-level barriers to care leveraging trusted community partners.

Health Affairs: (4/6) - CMS announced a new accountable care model that replaces the prior Direct Contracting models and incorporates changes to help organizations address equity and access through accountable care organization (ACO) participation. This article outlines how the ACO REACH model takes several foundational steps needed to prioritize equity in health care payment and model design.

Center for Health Care Strategies: (4/5) - California and New Jersey are leading examples of states pursuing groundbreaking efforts and making substantial investments to address adverse childhood experiences (ACEs). This blog post highlights how California and New Jersey are approaching preventing and mitigating the effects of early adversity on children and families as well as supporting resilience-building in their communities.

Yahoo Finance: (4/5) - Activate Care and Nomi Health have partnered to launch Path Assist, a full-service offering which enables persons at risk for impacts from SDOH to be identified and served. The platform features a proactive model of care that combines local people, curated processes, and patient care technology. Path Assist also helps navigate individuals through an intervention to improve patient outcomes and lower costs of care.

 Spotlight on Maternal Health 

New York Department of Health: (4/13) - The New York State Department of Health released a new report on maternal mortality as part of the state’s commitment to addressing systemic inequities and creating safer birth experiences for mothers and families. In addition to the published findings, Governor Hochul’s FY2023 Enacted Budget includes over $20 million in annual investments designed to expand access to holistic prenatal and postnatal care to make quality care accessible for all mothers.

Business Wire: (4/11) - The Bump, a multi-platform brand for pregnancy and parenting, announced the expansion of its Black Maternal Health Hub. This platform provides advice and insights for expecting Black parents. The Bump will also partner with notable medical doctors and experts to provide thoughtful, informative content and engage with consumers.

UnitedHealth Group: (4/11) - UnitedHealthcare, Mountain Area Health Education Center, and SistasCaring4Sistas announced the expansion of a community-based doula program into western North Carolina. The Doulas for Social Justice program aims to improve maternal health outcomes among Black women and reduce racial and social disparities among mothers in the region by providing access to quality health care.

Health Leaders: (4/11) - Rising maternal death rates are caused in part by maternity deserts with little or no access to prenatal or delivery services, but this could be curbed if states granted full practice authority to nurse practitioners. Nurse practitioners can help connect mothers with programs that can assist them if they are lacking something or require additional assistance to get food or supplements, or other needed health needs.

Patient Engagement HIT: (4/6) - A new report from the Commonwealth Fund doubles down on data stating that the United States has the worst maternal mortality rate in the developed world. Women of reproductive age in the US are among the least likely to have a usual doctor or source of care. The total maternal mortality rate in the US came in at 23.8 deaths per 100,000 live births, a figure that dwarfs even the nation with the second-highest maternal mortality rate (France, with a rate of 7.6 deaths per 100,000 live births). Much of this is largely driven by steep maternal health equity problems.

Business Wire: (4/5) - Northwell Health announced the launch of a Center for Maternal Health, the linchpin in a high-tech, high-touch campaign to reduce the country’s maternal mortality rate and address the health risks facing Black women in America. This new center takes a 360-degree approach to improving maternal health, working throughout the care continuum and in the community to address health and social needs that raise the risk of maternal health problems among Black women.

Patient Engagement HIT: (4/5) - March of Dimes and Deloitte’s Health Equity Institute are working to allay the nation’s maternal health equity data problems. In a new partnership, the organizations have created an interactive dashboard that displays SDOH information, chronic disease data, and maternal morbidity and mortality figures all in one place.

 Data and Innovation 

US News & World Report: (4/7) - To effectively address health inequities in a targeted way, we have to understand what the disparities are and where the people experiencing them live. Combining data from a range of sources to create a cohort and person-centric view of a population is one way to do this. This article focuses on how data can drive a deeper understanding of health disparities and how to solve them.

Health Leaders: (4/4) - Developing effective social determinants measures depends on deep planning, data volume, multifactor problem-solving, and collaboration. The best measures straddle the non-negotiable and often-competing aspects of health care ROI: patient outcomes and financial. In this article, Trenor Williams of Socially Determined detailed five steps to create effective measures for SDOH that improve health outcomes and business performance.

 New Research and Reports

Patient Engagement HIT: (4/12) - Research from the American Heart Association found that social determinants of health have had severe implications for people born with congenital heart diseases and their ability to access specialty treatment throughout their lives, particularly when transitioning from pediatric to adult care. A new American Heart Association scientific statement published in the Journal of the American Heart Association explored how the various levels of SDOH impact patients born with congenital heart disease.

Healio: (4/7) - A study published in Supportive Care in Cancer found that survivorship care plans are not being provided to vulnerable populations that may have a particular need for them. Researchers sought to determine the role social determinants of health played in the distribution of survivorship care plans, and discussed the discrepancies in the provision of survivorship care plans and the reasons for these gaps in this article.

Patient Engagement HIT: (4/6) - A study by the LeadingAge LTSS Center @UMass Boston and the Center for Consumer Engagement in Health Innovation at Community Catalyst found there is a growing racial and economic divide in the receipt of patient-centered care, with minority and low-income patients having their care preference taken into account less frequently than White patients. Overall, one-third of older patients stated that their care preferences were either never or only sometimes taken into account.

The Commonwealth Fund: (4/6) - Medicaid’s dramatic growth, coupled with its transformation into an active health care purchaser, has elevated the role of safety-net providers in ensuring health care access and promoting health equity. Given the heightened focus on equity for low-income populations, communities of color, people with complex medical conditions, and medically underserved communities, it is an important time to examine the implications of Medicaid’s evolution for these essential providers. This report describes Medicaid’s evolution as a health care purchaser, examines the implications for safety-net providers, and discusses strategies to better ensure health equity for enrollees.

UC Davis Health: (4/6) - A recent UC Davis Health study analyzed transportation screening and assessment questions used in adult clinics to understand how these tools assess patients’ mobility and transportation needs. The study found that current social risks screenings do not capture patients’ transportation needs. The author of the study describes these findings in more detail in this Q&A.

Yahoo News: (4/5) - A data brief from ATI Advisory and the Long-Term Quality Alliance outlined new, non-medical benefits in Medicare Advantage (MA) and benefit growth since implementation of the CHRONIC Care Act in 2020. The brief focuses on expanded MA supplemental benefits that help address Medicare beneficiaries’ broader social needs, including social determinants of health needs and long-term services and supports. This year, nearly one in every three MA plans offers one of these new, non-medical benefits.

Patient Engagement HIT: (4/5) - A recent Health Affairs study found that people living in predominantly Black neighborhoods in Boston may have to wait longer to see their housing code complaints resolved, particularly those that lead to asthma triggers like mold. The study found that for every 10 percent decrease in neighborhood proportion of White residents, there were 3.14 per 1,000 people more reports of asthma triggers stemming from housing code issues. Those code reports took longer to resolve in predominantly Black neighborhoods or were less likely to be resolved at all.

Health Affairs: (4/4) - Among older adults enrolled in Medicare Advantage, health-related social needs are highly prevalent, with financial strain, food insecurity, and poor housing quality the most commonly reported. The distribution of health-related social needs is uneven, with significant disparities according to race, socioeconomic status, and sex. This study explores the burden of health-related social needs among older adults enrolled in Medicare Advantage, finding a high collective burden of health-related social needs among this population.

Journal of the American Board of Family Medicine: (March 2022) - This study found that family physicians who identify as underrepresented minorities in medicine were more likely to have a larger percentage of vulnerable patients in their panels. Increasing access to care for vulnerable patient populations will require a combination of advocating for policies to diversify the physician pipeline and those that encourage all primary care physicians to care for vulnerable patients.

Annals of Family Medicine: (March 2022) - Because social conditions such as food insecurity and housing instability shape health outcomes, health systems are increasingly screening for and addressing patients’ social risks. This study documented the prevalence of social risks and examined the desire for assistance in addressing those risks in a US-based integrated delivery system.

Upcoming Events

April 

• April 15 - University of Pennsylvania, “Addressing Structural Racism in Medicaid to Promote Health Equity.” Virtual.

• April 20 - Cure, “Why an Organization’s Legacy is Fundamentally Connected to Advancing Health Equity.” Virtual.

• April 21 - Bipartisan Policy Center, “Getting Serious About Housing Supply: Corporate Initiatives to Boost Housing Availability.” Virtual.

• April 22 - HHS ONC, “SDOH Information Exchange: Vision, Purpose, and Community Engagement.” Virtual.

• April 26 - Health Affairs & Society of Health Policy Young Professionals, “Lunch & Learn: Food Insecurity and Other Health-Related Social Needs Among Older Adults.” Virtual.

• April 27 - National Association of Community Health Centers, “PRAPARE and Addressing SDOH: Integration is Not As Hard As You Think.” Virtual.

• April 28 - TCA Health Center, “Addressing Barriers to Diabetes Management for Residents of Public Housing.” Virtual.

• April 28 - CMS, “CMS Health Equity Symposium.” Virtual.

May

• May 4 - Johns Hopkins Urban Health Institute, “2022 Social Determinants of Health Symposium.” Virtual.

• May 10 - 12 - American Hospital Association, “Accelerating Health Equity Conference.” Cleveland, OH

• May 12 - Congressional Black Caucus Foundation, “Health Equity Summit.” Virtual.

• May 12 - SDOH Academy Innovations Showcase, “Helping Health Centers Build Healthier Communities.” Virtual.

• May 13 - HHS ONC, “SDOH Information Exchange: Governance.” Virtual.

• May 19 - Stanford Center for Continuing Medical Education, “Building a Culture of Health Equity Summit.” Virtual.

June/July

• June 14 - HHS ONC, “SDOH Information Exchange: Technical Infrastructure and Interoperability.” Virtual.

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

SDoH Opportunities

April

• Deadline: April 18 - CMS, Request for Information: Access to Coverage and Care in Medicaid & CHIP

• Deadline: April 22 - National Institutes of Health, Funding Opportunity: Transformative Research to Address Health Disparities and Advance Health Equity at Minority Serving Institutions

• Deadline: April 22 - SIREN, Call for Proposals: SIREN 2022 National Research Meeting - Racial Health Equity in Social Care

• Deadline: April 22 - Association of Maternal & Child Health Programs, Congressional Sign-On Letter: Support FY2023 Surveillance for Emerging Threats to Moms and Babies Network (SET-NET) Appropriation

• Deadline: April 24 - Academy Health, Request for Proposals: 2022 Health Equity DataJam

May/June

• Deadline: May 23 - National Institutes of Health, Funding Opportunity: Transformative Research to Address Health Disparities and Advance Health Equity at Minority Serving Institutions

• Deadline: May 31 - CMS, Request for Information: FY2023 Inpatient Psychiatric Facilities Prospective Payment System - Rate Update and Quality Reporting - Principles for Measuring Healthcare Quality Disparities

• Deadline: May 31 - CMS, Request for Information: FY2023 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements - HQRP Health Equity Initiative

• Deadline: May 31 - CMS, Request for Information: Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2023 and Updates to the IRF Quality Reporting Program - Overarching Principles for Measuring Equity and Healthcare Quality Disparities Across CMS Quality Programs

• Deadline: June 28 - U.S. Department of Housing and Urban Development, Notice of Funding Opportunity: Youth Homelessness Demonstration Program

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

• Deadline: Open - Data Across Sectors for Health, Survey: 2021 National Inventory of Data Sharing Collaborations for Health