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.
American Hospital Association: (7/7) - In this blog, chairperson of the American Hospital Association’s Institute for Diversity and Health Equity Leadership Council Kimberlydawn Wisdom, MD, MS outlines how now is the time to move beyond equity to achieve justice in health care, but there are barriers on the road to equity that need to be addressed to get there. Wisdom proposes a call to action, which includes knowing who you are serving and whether disparities exist by collecting self-reported data and stratifying data by race/ethnicity; removing barriers to behavioral health communications by offering messaging in ways that are accurate, culturally competent, relevant, and appropriate to the specific communities of color being addressed; and other key ideas.
Aunt Bertha: (6/30) - The DePaul Community Health Centers (DCHC) partnered with Aunt Bertha in April 2018 to begin the Care Fellowship initiative to address social determinants. Aunt Bertha supported DCHC in creating a coordinated approach that proactively identifies and fulfills the needs of its patients. Through this partnership, DCHC’s closed-loop referral rate has grown to 70 percent in the three years since its staff first adopted its whitelabel version of Aunt Bertha’s search platform.
HIT Consultant: (6/30) - Kaiser Permanente and AlohaCare are partnering with Unite Us to implement the first-ever coordinated care network throughout the state of Hawaii. The Unite Hawaii network will bridge the care gap statewide for individuals in need with a single, seamless network enabling real-time service delivery for communities, and secure, trackable social service referrals focused on improving long-term health outcomes. The network will also connect Kaiser Permanente and AlohaCare with local community-based organizations to improve patient access to services like affordable housing and food banks.
Anthem: (6/30) - Anthem, a health plan of the Blue Cross Blue Shield Association, has been building and supporting programs that reduce food insecurity and improve access to healthy food in the communities it serves. Throughout COVID, Anthem has delivered over one million meals to food-insecure Medicare and Medicaid members and integrated medically tailored meals and food delivery into affiliated health plan benefits. The Anthem Foundation's Food is Medicine program has expanded into an additional seven Feeding America member food banks across the country and helped screen over 100,000 people for food insecurity in 2021.
Signify Health: (6/29) - Signify Health has partnered with Humana and the Alamo Area Community Network (AACN) to support Humana Medicare Advantage members in San Antonio through AACN’s community resources and by connecting those in need with health-related social services. AACN uses Signify Health’s proprietary technology platform to collaborate compliantly and securely to ensure people’s needs are being met and to close the loop on referrals between AACN participants. Signify Health’s Social Care Coordinators will also provide outreach to Humana members to help them resolve unmet needs.
WYSO: (6/28) - Karin VanZant of CareSource outlined the health plan’s work to help Medicaid beneficiaries find the health care and social service supports they need to address their overall wellbeing in a recent interview. VanZant highlighted CareSource’s work to create a social service network similar to its medical network to help connect Medicaid clients to social service organizations to address their SDOH needs. The health plan’s ultimate goal is to meld its social services and medical networks into a single institution capable of helping people overcome obstacles to their health and wellbeing.
CareSource: (6/28) - CareSource received the 2021 Secretary’s Award for Public-Philanthropic Partnerships, which is an award from the US Department of Housing and Urban Development in partnership with the Council of Foundations that recognizes partnerships that impact the quality of life for low- to moderate-income individuals. CareSource was recognized for its partnership with Ohio community partners through the Healthy Beginnings at Home program, which supports members through housing stabilization and addressing infant mortality.
Unite Us: (6/24) - Even before the COVID-19 pandemic, individuals and families were increasingly in need of food assistance. Unite Us aims to address the root causes that can lead to an individual or family needing access to food assistance, and to help connect those in need to additional resources. This blog outlines how Unite Us connects individuals to food assistance, and how referral data tracked through the Unite Us platform can be used to identify coverage gaps and prompt connections between organizations in the community that may benefit from a strategic partnership.
Forward Momentum on the Social Determinants Accelerator Act!
On Thursday, June 24, the House Energy & Commerce Committee, Subcommittee on Health held a legislative hearing entitled “Empowered by Data: Legislation to Advance Equity and Public Health.” Aligning for Health is thrilled that the Subcommittee convened this hearing to examine 13 bills focused on public health and social determinants of health. See here
for a full list and descriptions of the bills discussed, and here for our Statement for the Record.
Aligning for Health: (7/6) - Aligning for Health sent a letter to the leaders of the House Energy & Commerce Committee and Health Subcommittee, thanking them for their leadership in holding a hearing to discuss and consider important legislation related to social determinants of health. Aligning for Health expressed support for the forward momentum towards passage of the Social Determinants Accelerator Act (H.R. 2503). Included in the letter is an updated endorsement list – which now totals well over 100 leading health and social services organizations who support passage of the legislation.
Healthcare IT News: (7/7) - Several health and social services organizations have advocated for the passage of the bipartisan Social Determinants Accelerator Act of 2021. Aligning for Health sent a letter this week to leaders of the House Energy and Commerce Committee, outlining how this legislation would empower communities to share data across sectors, foster partnerships, and make use of available resources and coordinate care. As noted in the letter, “Taken together, these elements will address the complexity that often stymies innovative cross-sector efforts or limits the scope and scalability of initiatives at the state and local level.”
Inside Health Policy: (7/7) - Aligning for Health spearheaded a letter of support for the Social Determinants Accelerator Act, a bill that would create an interagency council responsible for awarding up to 25 grants to state, local, or tribal health or human service agencies to develop social determinants accelerator plans. Over 100 health and social services organizations are supporting the passage of this bill, including the American Medical Association, America’s Health Insurance Plans, and Uber Health.
Becker’s Hospital Review: (7/7) - A recent letter penned by Aligning for Health voiced support for the House Energy and Commerce Committee to advance the Social Determinants Accelerator Act. The letter features an appended section outlining the health care and social service organizations that support the legislation, including Blue Cross Blue Shield Association, Humana, Centene, and others.
Patient Engagement HIT: (6/28) - In a recent interview with Patient Engagement HIT, Rep. Cheri Bustos (D-IL) discussed the Social Determinants Accelerator Act, which she cosponsors and was recently discussed at a House Energy and Commerce Committee hearing. When asked about the bills, Bustos said “If you took a listen to the Energy & Commerce Committee today, we literally had eight members on that committee, Republicans and Democrats, who are co-sponsors and spoke out in favor of the Social Determinants Accelerator Act. We've worked really, really hard to make sure that we have bipartisan support of this. You could hear that support in today's hearing.” Bustos went on to highlight how this bill will help communities find the tools, resources, and have the funding to develop a plan to address SDOH specific to the local needs of the community.
Oklahoma Welcome News: (6/27) - Congressman Markwayne Mullin (R-OK) highlighted how his legislation would improve health outcomes during a recent House Energy and Commerce Health Subcommittee hearing. Mullin’s bill, the Social Determinants Accelerator Act of 2021, would help states and communities devise strategies to leverage existing programs and authorities to address all aspects of health, including food, housing, transportation, and workforce. Known as social determinants of health, a focus on these non-medical factors can improve health outcomes and wellbeing.
Rep. Watson Coleman: (7/7) - Representatives Watson Coleman (D-NJ) and Swalwell (D-CA) led 40 colleagues in asking the HHS Secretary Xavier Becerra to issue guidance that federally-funded and federally-administered health insurers must cover all pregnancy and pregnancy-related services, including maternity care for dependents. The letter argues that failing to cover all costs of a dependent child, including for maternity care, violates Section 1557 of the Affordable Care Act’s policy against gender discrimination, and that allowing insurers to exclude all aspects of maternity care for dependents disproportionately impacts women of color.
TRIUMPH for New Moms Act: (6/29) - Reps. Barragan (D-CA), Bucshon (R-IN), Blunt Rochester (D-DE), and Kim (R-CA) introduced the Taskforce Recommending Improvements for Unaddressed Mental Perinatal & Postpartum Health (TRIUMPH) for New Moms Act of 2021 (H.R. 4217), which would provide for the establishment of a Task Force on Maternal Mental Health.
Native American Housing Assistance and Self-Determination Act: (6/24) - Sens. Schatz (D-HI), Murkowski (R-OK), Hoeven (R-ND), Tester (D-MT), Smith (D-MN), Cortez Masto (D-NV), Lujan (D-NM), and Rounds (R-SD) introduced the Native American Housing Assistance and Self-Determination Act (S. 2264), which would reauthorize the Native American Housing Assistance and Self-Determination Act of 1996 to build on successful Native American housing programs at the Department of Housing and Urban Development (HUD).
Closing the Meal Gap Act: (6/23) - Sens. Gillibrand (D-NY), Sanders (I-VT), Booker (D-NJ), Padilla (D-CA) and Warren (D-MA) introduced the Closing the Meal Gap Act of 2021 (S. 2192), which would require that supplemental nutrition assistance program benefits be calculated using the value of the low-cost food plan. Rep. Adams (D-NC) and 86 cosponsors introduced companion legislation in the House (H.R. 4077). A one pager on the bill can be found here.
Task Force on the Impact of the Affordable Housing Crisis Act: (6/23) - Sens. Young (R-IN), King (I-ME), Cantwell (D-WA), Kennedy (R-LA) and Tester (D-MT) introduced the Task Force on the Impact of the Affordable Housing Crisis Act (S. 2190), which would establish the bipartisan Task Force on the Impact of the Affordable Housing Crisis to better understand and respond to America’s housing affordability crisis. The task force would evaluate and quantify the impact of housing costs on other government programs and provide recommendations to Congress on how to increase affordable housing options in order to improve life outcomes.
Social Determinants of Health Data Analysis Act: (6/22) - Reps. Burgess (R-TX) and Blunt Rochester (D-DE) introduced the Social Determinants of Health Data Analysis Act of 2021 (H.R. 4026), which would require the Comptroller General of the United States to submit to Congress a report on actions taken by the Secretary of Health and Human Services to address social determinants of health.
To view a full list of the legislation we are tracking around social determinants of health, health equity/disparities, and maternal health, click here.
Representatives Cheri Bustos (D-IL), Tom Cole (R-OK), G.K. Butterfield (D-NC), and Markwayne Mullin (R-OK) invite you to join the launch of the newly formed bipartisan Congressional Social Determinants of Health Caucus. Join this webinar on July 21 to hear from these Members of Congress about this exciting launch and their expectations for the Caucus, as well as from guest speakers on the value this caucus will bring to addressing SDOH from the health and community-based organization perspective.
CMS: (7/6) - The CMS Accountable Health Communities Model bridge organizations are developing sustainable care delivery models to address social determinants of health. This case study publication highlights Alina Health’s partnership with Blue Cross and Blue Shield of Minnesota to build on work accomplished under the model to develop their SDOH 2.0 strategy.
HHS: (7/2) - The White House COVID-19 Health Equity Task Force held its fifth public meeting on June 25, where they considered interim recommendations addressing inequities and the impact of long COVID, and access to personal protective equipment, testing and therapeutics.
CMS: (7/1) - CMS issued a proposed rule that would address health equity for chronic kidney disease and end-stage renal disease (ESRD) by making changes to the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model. The proposed changes to the ETC Model build on the current model by proposing to test a new health care approach that rewards ESRD facilities and managing clinicians participating in the model for achieving significant improvement in the rates of home dialysis and kidney transplants for lower income beneficiaries. If finalized, these changes would take effect Jan. 1, 2022. A fact sheet can be found here.
CMS: (6/28) - CMS released the proposed CY2022 Home Health Prospective Payment System Rate update, which would accelerate the shift from paying for home health services based on volume to a system that incentivizes value and quality. The proposed rule also seeks feedback on ways to attain health equity for all patients through policy solutions. A fact sheet can be found here.
HHS Office of Minority Health: (6/28) - HHS Office of Minority Health (OMH) announced $250 million in grant awards to 73 local governments as part of a new, two-year initiative to identify and implement best practices for improving health literacy to enhance COVID-19 vaccination and other mitigation practices among underserved populations.
SDoH in the News
Business Wire: (7/8) - SCAN Health Plan will launch the Healthcare in Action program, a new medical group that will provide health care and other services to individuals experiencing homelessness. The group’s focus will be on “street medicine” to older adults, who comprise one of the fastest growing segments of the homeless population. This group will help connect patients with community resources and other programs to address mental illness, substance use, and other root causes of homelessness, and will help these individuals to obtain housing.
Patient Engagement HIT: (7/7) - According to Sophia Thomas, the immediate past president of the American Association of Nurse Practitioners, nurse practitioners have had “their finger on the pulse of social determinants of health issues for decades.” Thomas emphasized the role nurse practitioners play in addressing SDOH given the unique relationships they often have with patients and ability to therefore uncover certain SDOH that could lead to worse health disparities down the road.
KOLD: (7/7) - The Arizona Alliance for Innovation on Maternal Health, or the AIM Collaborative, is a new initiative launched in May, formed to ensure that Arizona hospitals are working to improve maternal health outcomes. The AIM Collaborative brings together 33 hospitals across the state to help combat pregnancy-related deaths and address underlying causes using evidence-based strategies. The collaborative will provide “pregnancy bundles” to hospitals, which is a list of practices for medical staff and patients to reduce complications of hypertension by 20 percent over the next 18 months.
Maryland.gov: (7/6) - Maryland Governor Larry Hogan announced the launch of a $72 million maternal and child health care transformation initiative which will aim to improve related health disparities across the state. The program, which is focused on prevention and early intervention, will invest in access to prenatal care, postpartum care, and child health visits through new and expansion of existing state programs and health care services.
Digital Journal: (7/6) - Leaders at Intermountain Healthcare are taking steps to improve access to health care for patients by centering health equity, which is now a mission-level value of the health system. Intermountain added equity to the health care system's fundamentals in September 2020, placing it on the same level as safety, quality, experience, access, stewardship and engaged caregivers. The health system has also created new system Equity Dashboards to examine existing key performance indicators with already known patient information about race, ethnicity, sex, and other equity measures. The dashboards are meant to help providers look at their own outcomes and develop standardized ways to assess inequity and identify health disparities.
Insider NJ: (7/2) - New Jersey Governor Phil Murphy signed legislation that will allow hospitals to construct housing and provide wraparound services for individuals experiencing homelessness or housing insecurity. On this bill, Governor Murphy commented, “As New Jersey emerges from the COVID-19 pandemic that has caused severe economic and social disruption, we must think creatively about ways to reduce housing instability and improve access to services. I commend my partners in the Legislature for their efforts to eliminate housing insecurity and improve the health of New Jerseyans.
Health IT Analytics: (7/1) - The Institute for Translational Research at the University of North Texas Health Science Center at Fort Worth is providing data on early demographic and social determinants to scientists to better understand the biology of Alzheimer’s disease. The demographic data, which comes from the Health and Aging Brain among Latino Elders study, is aimed to help providers improve population health management for diverse communities and eliminate health disparities that might contribute to development of this disease.
What to Expect: (7/1) - About 2.2 million women currently live in a “maternity care desert,” or a US county where access to maternity care is limited or absent. About 54 percent of counties are considered full maternity care deserts, according to March of Dimes president and CEO Stacey Stewart, areas that tend to have higher poverty rates and lower median household incomes. Long drive times to access prenatal and maternity care can limit how frequently a woman is seen by a prenatal care practitioner, which can lead to negative health outcomes for both the mom and baby.
Mobi Health News: (6/30) - Google launched a new website called Find Food Support which includes a Google Map locator tool and destigmatizing online resources aimed at addressing food insecurity. Launched in collaboration with No Kid Hungry, FoodFinder, and the US Department of Agriculture, this website pinpoints 90,000 locations with free food support across the country, can help individuals find the nearest food bank or school lunch pickup site, and has links to resources like Meals on Wheels.
NY Daily News: (6/30) - In this article, Dr. Jeffrey Brenner, a family physician in New York, described how homeless shelters do not solve the entrenched problem of homelessness and that an apartment has proven to be the most powerful medication he has observed in his homeless patients over his career. He makes the case for a “cure” to homelessness, which involves an apartment with specialized supports provided by a team of behavioral care experts. Called Housing First, this model moves individuals directly into an apartment with a trained team, supported by innovative treatment approaches like patient-centered care planning. Brenner said this also needs to be viewed as a statewide problem that needs a statewide solution to create supportive housing for anyone who wants to relocate.
Community Impact Newsletter: (6/30) - In a recent interview with Community Impact Newspaper, Dr. Tim Mercer of the Dell Medical School at the University of Texas spoke about his leadership on the school’s work with the homeless population in Austin, Texas. He spoke about health care services for homeless individuals in the city and providing care for this population during the COVID-19 pandemic.
Medscape: (6/29) - Health care providers are starting to increasingly acknowledge the role social determinants of health can play in overall health outcomes and how to address SDOH to improve health and wellbeing. This article outlines four different approaches to address SDOH: standardize, individualize, act, and advocate.
The Suburban Times: (6/29) - The Community Health Plan of Washington (CHPW) donated $250,000 to support 25 community-based organizations to address health equity and disparities in the communities they serve. CHPW is investing in local partnerships to increase access to vital, community based health care and social services for people of color and other populations who experience health disparities. Organizations receiving this funding provide direct services to support people of color in meeting their needs in culturally responsive and sensitive ways.
Becker’s Hospital Review: (6/28) - This article outlines what eight hospitals and health systems are doing to address health equity as a top priority within their organization. Rush University Medical Center, for example, had providers go into homeless shelters to test people for COVID-19 and created a respite center for homeless individuals with COVID to recover and reduce transmission of the disease. The center has taken care of over 700 homeless patients since April 2020.
Fierce Healthcare: (6/28) - Marshfield Clinic Health System partnered with NowPow to better connect patients living in rural areas with the social services they need. NowPow’s SDOH platform will help community resource groups screen patients for social needs and connect patients to nearby social services. While the tool is meant to target the highest risk populations, the goal is to prioritize the most relevant and important populations to initially address and work with community partners to ensure this happens.
Idea Stream: (6/25) - MetroHealth received $901,000 in funding from the Federal Communications Commission to provide high-speed, low-cost internet to residents in public housing in the Cuyahoga Metropolitan Housing Authority buildings. Addressing the digital divide to ensure more individuals can access the health care services they need will help improve health outcomes and address issues like social isolation and transportation barriers.
Health Affairs: (6/24) - Health funders are increasingly collaborating to fund research, grant making, technical assistance, and field-building activities to address health and social needs. A collaboration between Robert Wood Johnson Foundation and the Episcopal Health Foundation is one such example, as over the past five years this partnership has helped to further understanding on how to integrate social determinants of health within the Medicaid managed care environment, among other areas. This blog outlines this partnership and the advances made in this area as a result.
Center for Health Care Strategies: (June 2021) - In this episode of the Medicaid Leadership Exchange podcast, Tracy Johnson, Medicaid director at the Colorado Department of Health Care Policy and Financing, and Caprice Knapp, director of the medical services division at the North Dakota Department of Human Services, share strategies on how to have discussions with budget staff and legislators about investing in infrastructure that supports long-term health equity goals.
New Research and Reports
Patient Engagement HIT: (7/6) - New data published in the Journal of Women’s Health found that 11 percent of perceived financial care access barriers were linked to lost pay and the cost of transportation. The study looked at cervical cancer screening, and found that only 64 percent of uninsured women, 78 percent of publicly insured women, and 75 percent of low-income women have received cervical cancer screening. About 72 percent of respondents reported financial barriers in accessing preventive care, 71 percent listed the cost of the appointment as a barrier, and 44 percent listed the cost of potential follow-up care as a discouraging factor in accessing such services.
Health Affairs: (7/6) - Despite restrictive immigration policies being an important SDOH, little is known about the health implications and health-related content of protective immigration policies, which can represent critical determinants of health. This content analysis of types, themes, and health-related language in 328 sanctuary policies between 2009 and 2017 found that health-related themes commonly co-occurred with language related to supporting immigrants in communities, including themes of antidiscrimination, inclusion, trust, and privacy.
Patient Engagement HIT: (7/6) - New data published in JAMA Network Open found that safety net hospitals were still seeing a higher proportion of Black and Hispanic patients from high-poverty neighborhoods even after Medicaid expansion promised to boost hospital racial integration and health equity. The data showed that despite advances in health care coverage that came with Medicaid expansion, low-income individuals and those from historically marginalized populations were still seeking care from low-cost care settings.
Patient Engagement HIT: (7/5) - The United Health FoundationAmerica’s Health Rankings Health Disparities Report revealed that educational attainment is a key social determinant of health influencing health disparities. Individuals without a high school education face the greatest barriers to accessing care, particularly for mental and behavioral health care. The report also found maternal health disparities and increased disparities in food insecurity for those without a high school diploma compared to those who have graduated college.
Medscape: (7/5) - A recent analysis published in JAMA Network Open found that most states created their vaccine distribution plans without getting advice from a health equity committee or input from minority communities. A health equity plan was referenced in only 20 vaccine distribution plans of the 43 states that created them, and minority populations often were not represented even when health equity was considered. Minority group representatives were present in only two-thirds of the 20 states with health equity committees, and in 16 percent of state vaccination plans.
AJMC: (7/1) - A study published in JAMA Network Open examined the rural-urban disparity in US mortality across two decades and found that systemic health and social inequities within rural communities have increased over time. The absolute difference in age-adjusted mortality rates (AAMR) between 1999 and 2019 increased by 172 percent, with non-Hispanic Black rural residents shown to have a greater AAMR than all other racial and ethnic groups with a 12.1 percent increase in the measure observed for rural residents age 25 to 64 years. These trends have only been exacerbated in the past year due to COVID-19.
Milbank Memorial Fund: (6/28) - This issue brief looks at the two-pronged approach many Medicaid programs are taking to address COVID-related health disparities - including short-term program changes through federal regulatory flexibility options and long-term efforts to address systemic biases and increase health equity. To reduce health disparities, Medicaid programs are making short-term changes such as ensuring access to Medicaid coverage, ensuring access to needed services, and improving data collection to better identify disparities and target interventions.
Revcycle Intelligence: (6/25) - A study in the Journal of the American Medical Association found that SDOH are associated with increased Medicare spending per beneficiary in certain geographic areas. Medicare spending was higher in geographic locations where residents had greater rates of SDOH. SDOH were indirectly associated with Medicare spending in that these factors can lead to chronic illnesses associated with increased health care costs. SDOH factors were also directly associated with Medicare spending in that low incomes and other financial disparities can prevent patients from seeking care or following medical advice, leading to ineffective treatment and increased spending.
NASHP:(6/25) - Data analysis is an essential tool for advancing health and racial equity. States are beginning to explore strategies to use COVID-19 and other public health data to advance health and racial equity, including convergence analysis, or using publicly available data sets. This brief outlines strategies states are implementing to better address persisting health inequities.
Milbank Memorial Fund: (6/25) - This article explores the ethical questions associated with “social prescribing.” In the United Kingdom, social prescribing is used in the National Health Service (NHS) to address nonclinical social and personal needs, such as loneliness, to improve well-being and lower costs. This is done by connecting patients with community assets that provide social and personal support. Although social prescribing can hold promise, evidence of their effects and effectiveness is limited. As more information on this strategy is gathered, it will be important to consider the associated ethical issues for patients, clinicians, social service workers, and community assets.
MACPAC: (June 2021) - Medicaid and supportive housing programs serve many of the same individuals, but collaboration between the two programs have been limited. State Medicaid programs are increasingly partnering with state and local housing authorities to assist beneficiaries in need of supportive housing. This issue brief describes how Medicaid programs pay for housing-related services. It reviews relevant subregulatory guidance issued by the Centers for Medicare & Medicaid Services (CMS) and the various federal Medicaid authorities under which states can cover housing-related services. It provides examples of how certain states braid multiple funding sources to provide supports for certain populations, and also discusses the use of health services initiatives (HSIs) under the State Children’s Health Insurance Program (CHIP) to identify lead exposure and fund abatement.
Prevention Institute: (June 2021) - In the “Changing the Landscape: People, Parks, and Power” publication, an approach is proposed to address park and green space inequities that prioritize building power among people closest to the problem so they can drive policy and system change solutions. The paper includes lessons learned from other public health movements that can benefit the park equity movement, and examples of promising green space equity policies.