American Hospital Association: (8/1) – Hospitals provide over $110 billion each year in community benefits, according to an American Hospital Associationad
in the Wall Street Journal highlighting the data and programs offered by hospitals. Such efforts include offerings such as neighborhood clinics, food banks, and programs to address food insecurity, affordable housing and more.
Vizient: (7/26) - While a person’s environment is the most important contributor to their overall health, the indicators for health inequity, social determinants of health and systemic bias often go beyond the visible. Measuring these indicators in a standardized, inclusive manner presents a unique challenge for hospitals and health systems, as the needs of their community go beyond the four walls of a facility and its patients. This blog by Vizient outlines the importance of sound measurement in achieving health equity.
Center for Employment Opportunities: (7/26) – The Center for Employment Opportunities (CEO) announced a partnership with Unite Us to provide essential health care services to participants receiving job training and placement at offices in Pennsylvania, Georgia, Oklahoma, and New York. CEO and Unite Us will connect formerly incarcerated individuals to resources and services through a shared technology platform, enabling them to thrive and live healthier lives.
Government Technology: (7/25) – Leaders in Crittenden County, AR have set out to advance long-term health outcomes by addressing social determinants of health for a region with a 22.9 percent poverty rate (twice the national average). The group, which received the CDC’s Closing the Gap with Social Determinants of Health Accelerator Plans grant, launched Connect Crittenden, powered by findhelp, this June. The website will play a key role in the strategic plan to facilitate collaboration between community organizations and health care systems and allow people to easily search for help from the privacy of their own computer or mobile phone.
American Hospital Association: (7/25) – On this episode of the American Hospital Association Chair File: Leadership Dialogue, Mikelle Moore, senior vice president and chief community health officer at Intermountain Healthcare, discusses the different roles that hospitals and health systems can take in advancing community health. Mikelle describes how Intermountain is tackling “some issues that take decades to solve,” such as addressing social determinants of health.
Lifting Local Communities Act: (8/2) - Sen. Rubio (R-FL) and six cosponsors introduced the Lifting Local Communities Act (S. 4735), which would ensure equal treatment for religious organizations in the Federal provision of social services programs, grantmaking, and contracting. The bill would codify religious protections in the delivery of dollars across federal social service programs. One-pager
Mental Health Workforce and Language Access Act: (7/28) - Sens. Heinrich (D-NM), Padilla (D-CA), Van Hollen (D-MD), Klobuchar (D-MN), Booker (D-NJ), and Warren (D-MA) introduced the Mental Health Workforce and Language Access Act (S. 4677), which would increase language access to mental health services at certain health centers. The bill would improve access to affordable services at community health centers and employ qualified mental health professionals who are fluent in a language other than English.
Global Food Insecurity Act: (7/27) - Sens. Casey (D-PA), Risch (R-ID), Boozman (R-AR), and Coons (D-DE) introduced the Global Food Insecurity Act (S. 4649), which would improve the comprehensive strategic approach for US foreign assistance to developing countries to reduce global poverty and hunger, achieve food and nutrition security, promote inclusive, sustainable agricultural-led economic growth, improve nutritional outcomes, especially for women and children, and build resilience among vulnerable populations.
Comprehensive Care for Dual Eligible Individuals Act: (7/27) - Sens. Brown (D-OH) and Portman (R-OH) introduced the Comprehensive Care for Dual Eligible Individuals Act of 2022 (S. 4635), which would establish an optional state-administered program to provide fully integrated, comprehensive, coordinated care for full-benefit dual eligible individuals under the Medicare and Medicaid programs. Such integrated programs would allow beneficiaries to choose a single program that can provide for their medical, long-term care, social, and behavioral needs.
South Asian Heart Health Awareness and Research Act: (7/27) - The South Asian Heart Health Awareness and Research Act (H.R. 3771) passed the House by a vote of 237-192. The bill authorizes HHS to establish programs that support heart-disease research and awareness among communities disproportionately affected by heart disease, including the South Asian population of the US. The bill now heads to the Senate for consideration.
National Advisory Council on Unpaid Meal Debt Act: (7/26) - Rep. Omar (D-MN) introduced the National Advisory Council on Unpaid Meal Debt Act (H.R. 8509), which would establish a National Advisory Council on Unpaid Meal Debt in Child Nutrition Programs, which would make policy recommendations to tackle school meal debt and student hunger, prevent stigmatization, and maintain program viability.
Rural Physician Workforce Production Act: (7/26) - Reps. O’Halleran (D-AZ) and Harshbarger (R-TN) introduced the Rural Physician Workforce Production Act (H.R. 8508), which would support rural residency training funding that is equitable for all States. The bill would improve Medicare reimbursement and enhance the current structure of the Medicare-funded graduate medical education program to bring more medical residents and doctors to rural areas.
Tribal Nutrition Improvement Act: (7/26) - Sen. Heinrich (D-NM) introduced the Tribal Nutrition Improvement Act (S. 4625), which would promote Tribal food sovereignty and improve nutrition in tribal areas, as well as make it easier for Native children to have equitable access to free meals at school. Reps. Leger Fernandez (D-NM), McGovern (D-MA), Stansbury (D-NM), and Gallego (D-AZ) introduced companion legislation in the House (H.R. 8502).
To view a full list of the legislation we are tracking around social determinants of health, health equity/disparities, and maternal health, click here.
White House: (8/2) – The White House and US Department of Treasury hosted a summit on Building Lasting Eviction Prevention Reform, focusing on the need for an all-out effort to build lasting reform – including through the use of remaining American Rescue Plan funds from Emergency Rental Assistance and State and Local Fiscal Recovery Fund assistance.
CDC: (8/2) - The US faces long-standing occupational health inequities, with underserved workers experiencing higher rates of injury and illness. Worker safety and health research has slowly begun to consider the role social determinants play in health outcomes. This blog, written by the National Institute for Occupational Safety and Health (NIOSH) Occupational Health Equity Program team, proposes how research can better address occupational health inequities.
CMS: (8/1) – CMS issued the final rule for the FY2023 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System. The final rule includes key provisions to advance health equity and improve maternal health. The rule establishes a “Birthing-Friendly” hospital designation, which will be awarded to hospitals that participate in a statewide or national perinatal quality improvement collaborative program and have implemented the recommended quality interventions. CMS is also adopting three health equity-focused measures in the IQR program – one to assess a hospital’s commitment to establishing a culture of equity and delivering more equitable care by capturing concrete activities across five key domains, and two to capture screening and identification of patient-level health-related social needs. Fact Sheet
SAMHSA: (7/29) - The Substance Abuse and Mental Health Services Administration (SAMHSA) released a blog that discusses diversifying behavioral health research and the impact this can have on addressing disparities.
CMS: (7/28) - CMS released a Request for Information seeking public comment on the Medicare Advantage (MA) program, asking for input on ways to achieve the agency’s vision so that all parts of Medicare are working towards a future where people with Medicare receive more equitable, high quality, and person-centered care that is affordable and sustainable.Questions address how MA can screen, document, and furnish health care informed by social determinants of health, standardized data elements to collect to better understand SDOH of beneficiaries, and other questions related to SDOH and health equity.
White House: (7/27) - White House Domestic Policy Advisor Susan Rice delivered remarks to the National Conference on Ending Homelessness, outlining efforts by the current Administration to address homelessness.
CDC: (7/26) - CDC announced two winners of the 2022 REACH Lark Galloway-Gilliam Award for Advancing Health Equity Challenge, which recognizes individuals and organizations that work to advance health equity, reduce health disparities, and improve health in groups disproportionately affected by chronic disease.
CMS: (7/26) - CMS unveiled its Maternity Care Action Plan to support the implementation of the Biden-Harris Administration’s Blueprint for Addressing the Maternal Health Crisis. The action plan takes a coordinated approach across CMS to improve health outcomes and reduce inequities for people during pregnancy, childbirth, and the postpartum period.
HHS: (7/26) - The Office on Women’s Health within HHS announced the winners of the first phase of the HHS Racial Equity in Postpartum Care Challenge and an investment of $8.5 million in initiatives designed to reduce pregnancy-related deaths and complications that disproportionately impact minority populations and those living in rural areas.
CMS: (7/26) - CMS approved the extension of Medicaid and CHIP coverage for 12 months after pregnancy in Connecticut, Massachusetts, and Kansas. As a result, up to an additional 19,000 people annually will now have access to Medicaid or CHIP coverage for a full year after pregnancy.
HHS: (7/26) - HHS released a report on insights gained from key informant interviews and an ASPE-hosted listening session on short-term opportunities for improving PCOR data infrastructure that addresses the needs of individuals with intellectual and developmental disabilities. The report highlighted opportunities to capture demographic data to support health equity for this population, among other areas.
HHS: (7/25) - HHS announced a proposed rule implementing Section 1557 of the ACA that prohibits discrimination based on race, color, national origin, sex, age, and disability in certain health programs and activities.
SDoH & Health Equity in the News
Health Affairs: (8/2) – Hospital stakeholders are ramping up efforts to build health equity into their core functions and considering what needs to be done operationally to do so as a result of recent CMS rulemaking. Authors in this piece suggest leveraging data that are available now through geographic social needs indices to take meaningful action on addressing social needs. Multisector collaboration with hospitals in high-social-needs areas to target specific quality measures through the development of focused interventions holds promise for maximizing the impact of hospital SDOH investment and improving the health status of those with the highest need.
Lumina Health Partners: (8/1) – In this episode of the Value-Based Care Insights podcast, host Daniel J. Marino and Amy Valley, Vice President of Clinical Strategy and Technology Solutions at Cardinal Health, discuss the importance of incorporating social determinants into care management. As technology advances to better capture SDOH factors, clinicians can explore new ways to integrate this data into clinical workflows to proactively identify patients at high risk for adverse outcomes – resulting in better quality care.
AcademyHealth: (8/1) – This blog post outlines the Agency for Healthcare Research and Quality’s (AHRQ) new list of core competencies for learning health systems (LHS). A new domain was recently added to address health and health care inequities by applying LHS science methods in health care delivery systems, with competencies including assessing how existing health inequities affect population-level health and applying methods to optimally engage diverse participants in LHS initiatives.
Cigna: (7/29) – Cigna announced it will provide its Medicare Advantage beneficiaries rides to community cooling centers as temperatures rise this summer, to ensure such beneficiaries can safely find relief from the heat. Any Medicare Advantage customer with a transportation benefit can now use this service throughout the summer at no extra cost.
American Journal of Public Health: (7/28) – Encouraging health insurers to apply the business approach of co-opetition could be key to tackling SDOH. This approach would encourage competing health systems to jointly invest in the infrastructure of collaboration between community-based organizations and health plans to address social determinants, which, together with government policies to encourage co-opetition, could result in a major increase in investment in cross-sector referral systems, trusted structures to facilitate collaboration, and other essential elements needed to tackle upstream factors that influence health.
Healthcare Innovation: (7/27) - In an amendment request to its 1115 Medicaid waiver, New York State is proposing a $325 million investment in nine Health Equity Regional Organizations (HEROs) that would serve as coordinating entities for formalized partnerships between managed care organizations, hospitals, community-based providers, and other stakeholders. HEROs would focus on collaboration and coordination, and facilitation of activities that best address the needs of the communities they serve, with the goal of raising the overall health of these communities.
Health Affairs: (7/27) – Primary care teams play a critical role in prevention, controlling common chronic diseases, addressing social determinants of health, and coordinating testing and specialist care when it’s needed. Over time, they become trusted advocates for patient health and well-being. Investing more in primary care will make the health care system more efficient and improve patient experience by making care more accessible and responsive—ultimately improving health and increasing equity.
Behavioral Health Business: (7/27) – Behavioral Health Business sat down with Dr. Meena Seshamani, CMS deputy administrator and Director of the Center for Medicare, to talk about behavioral health, equity and policy. Dr. Seshamani discussed how CMS is addressing social determinants of health when it comes to behavioral health care within the Medicare program.
The Hill: (7/25) – America’s current housing shortage is not just a consequence of challenges brought on by the COVID-19 pandemic, but decades of underproducing entry-level homes and more than a century’s worth of policy decisions. Experts say the path forward is to make a different set of policy choices, such as updating zoning laws, removing stigma around manufactured housing, invigorating the workforce, and closing the racial gap.
Business Wire: (7/25) – Morgan Health and NORC at the University of Chicago partnered on an analysis
that found many Americans who depend on employer-sponsored health care are managing complex, costly health conditions and face significant gaps in diagnosis and disease management across race, ethnicity, and income levels. Even with employer-sponsored coverage, some enrollees have unmet social needs that can further exacerbate gaps in health outcomes.
Spotlight on Maternal Health
OHSU: (8/4) – A study by the Oregon Health & Science University (OHSU) found that replacing or supplementing in-person maternal care with telehealth generally results in similar, and sometimes better, outcomes compared with in-person care. The study found telehealth strategies were especially promising for certain health services, such as the treatment of postpartum depression and remote monitoring of conditions like diabetes and hypertension during pregnancy.
Bloomberg Law: (8/4) – According to a new report released by the CDC National Center for Health Statistics, Black, Native Hawaiian, and Pacific Islander women continued to have the highest fetal mortality rates in 2020. The fetal mortality rate among non-Hispanic Native Hawaiian or Other Pacific Islander women was 10.59 per 1,000 live births and fetal deaths in 2020, an increase from 10.03 in 2019. The rate for Black women was 10.34, which fell from 10.41 in 2019. Asian women saw the lowest fetal mortality rate at 3.93, followed by White women with 4.73.
Maternal and Child Health Journal: (8/3) - The Maternal and Child Health workforce, public health practitioners, researchers, and other groups need clear, practical guidance on how to promote health equity in the communities they serve. As such, the National Maternal and Child Health Workforce Development Center's Health Equity Team synthesized eight approaches for promoting health equity that drew on their experience working with public health practitioners and communities.
August is National Breastfeeding Month - a time for collective action and advocacy to create a landscape of support for new families. Learn more here.
Data and Innovation
NCQA: (8/1) – The National Committee for Quality Assurance (NCQA) announced new and revised measures for health plans in the Healthcare Effectiveness Data and Information Set (HEDIS) for measurement year 2023. Notable updates include the introduction of race/ethnicity stratifications and revisions to acknowledge and affirm member gender identity. NCQA also added a measure for social needs screening and intervention to help health plans identify specific needs and connect members with resources to address unmet social needs.
Revcycle Intelligence: (7/27) - Physicians have had the ability to document SDOH since ICD-10 was adopted in 2015, but recent CMS guidance now adds greater awareness to the health impact of these conditions. By including these risk factors in the patient diagnosis, providers can substantiate the increased complexity of these cases. They can also demonstrate the need for higher levels of care and additional care planning.
News Medical: (7/26) – In a new commentary in the journal of Population Health Management, commentators called for consistent measurement across the SDOH industry landscape. The authors note that little focus has been placed on the rigorous evaluation of SDOH interventions used by companies in this industry, increasing the risk that they will have a limited impact, and called for new measurements to evaluate SDOH need, both broadly and among people of color.
New Research and Reports
The Commonwealth Fund: (8/4) – The CMS Innovation Center (CMMI) addresses social determinants of health in many of their care payment and delivery models, but lessons from them have not yet been synthesized. This issue brief describes how CMMI models have addressed SDOH-related needs and identifies factors facilitating or hindering participants from addressing these needs. In 23 of 40 models, participants addressed SDOH-related needs to some degree.
Urban Institute: (8/4) – As health care payers increasingly focus on paying for value over volume, value-based payment (VBP) approaches and quality measures have proliferated. To the extent that social risks outside providers’ control affect health outcomes, VBP approaches could inadvertently penalize providers that see patients who face social risks. This brief
summarizes a panel of national experts brought together by the Urban Institute to discuss how to account for social risk in VBP and quality measurement.
Patient Engagement HIT: (8/2) – According to a recent survey by the University of Michigan, neighborhood and built environment have a big impact on social isolation, with the survey showing mixed results regarding social isolation during COVID-19. Factors like built environment and neighborhood culture influenced whether the pandemic’s social distancing guidelines helped or hindered social isolation, with more than a quarter of adults saying they felt more intense social isolation after the pandemic due to decreased quality and quantity of interactions with neighbors.
Healthcare Innovation: (8/2) – A recent survey of health care executives by Vantage Health Technologies found that the majority of health care executives (95 percent) believe health equity is important, but nearly half (43.5 percent) have no roadmap to address these issues. Additionally, 48.3 percent of survey respondents say they don’t know if they have race, ethnicity, or language data on their care population, and other responses indicate that factors such as data challenges, resource limitations, timing and prioritization, and budget present barriers in implementing health equity initiatives.
Health Affairs: (8/1) – Algorithms are currently used to assist in a wide array of health care decisions, however there is growing recognition that they may lead to unintended racially discriminatory practices, raising concerns about the potential for algorithmic bias. This study by RAND Corporation researchers describes two applications in which imputation of race and ethnicity can help mitigate potential algorithmic biases: equitable disease screening algorithms using machine learning and equitable pay-for-performance incentives.
Milbank Memorial Fund: (8/1) - Last year, TennCare Health Starts Initiative launched the Health Starts Provider Partnerships, which selected health care provider groups to participate and co-designed workflows within each organization. This issue brief outlines how the practices are integrating support for social risk factors such as conducting screening, implementing consistent referral pathways, and developing processes for member follow-up and data gathering.
Healio: (8/1) - The LGBTQ+ adolescent population experiences health disparities due to barriers to care, including lack of access to culturally competent health care providers. The purpose of this quality improvement project was to increase access to culturally competent care through continuing education, a physical makeover of clinic space, and a social marketing campaign. Results demonstrated that continuing education can be an effective way to increase cultural competence for the care of LGBTQ+ individuals.
AMA Journal of Ethics: (August 2022) - Access to care is a health determinant because health care resources, interventions, and personnel help maintain health and well-being. In addition to social determinants’ roles in health inequity, clinicians’ racial bias undermines the quality of Black persons’ health care experiences and is a pathway to iatrogenic harm. This study considers pain management and limb amputation outcomes as examples of how clinicians’ racial biases exacerbate inequitable access to health care for Black people in the U.S.
Current Treatment Options in Psychiatry: (7/28) – Social determinants provide a transdiagnostic, comprehensive, and actionable approach to studying and accounting for contextual factors that are relevant for PTSD. While some SDOH factors have been studied previously as standalone characteristics, there are numerous gaps in the current literature regarding the associations between SDOH and PTSD, the purpose of this study.
Trust for America’s Health: (7/28) – Trust for America’s Health released a new report on the impact of chronic underfunding in America’s public health system, which examines federal, state, and local public health funding trends. The report recommends investments and policy actions to build a stronger public health system, prioritize prevention, and address the ways in which social and economic inequities create barriers to good health in many communities – including by addressing health inequities and their impact on root causes of disease by addressing SDOH.
The Lancet: (7/27) - Homelessness, opioid dependence, justice involvement, and psychosis are each associated with an increased risk of poor health and commonly co-occur in the same individuals. Most existing studies of mortality associated with this co-occurrence rely on active follow-up methods prone to selection and retention bias, and focus on a limited set of specific exposures rather than taking a population-based approach. This retrospective cohort study used linked administrative data to address these limitations.
Health Services Research: (July 2022) – The purpose of this study was to advance equity by developing stakeholder-driven principles of shared measurement, which is using a common set of measurable goals that reflect shared priorities across communities and systems, such as health care, public health, and human and social services. The researchers developed a set of five guiding principles, which leaders across systems and communities can use to reimagine and transform how systems create equitable health by centering the needs and priorities of the communities they serve.
Currents in Pharmacy Teaching and Learning: (July 2022) - The purpose of this study was to assess if using computer simulations as a supplemental tool for teaching social determinants of health would impact first-year pharmacy students' knowledge and perceptions of SDOH. The study found that computer simulations can be utilized as a supplemental tool to teach and apply clinical patient cases focused on SDOH and that strategically threading SDOH throughout the pharmacy curriculum is recommended to further develop SDOH knowledge and clinical skills.