Social Determinants Updates


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December 3 to December 17, 2021

Welcome to Aligning for Health's bi-weekly Social Determinants Updates newsletter. This will be our last newsletter of 2021. We wish you and yours a happy, healthy holiday season!

Do you have an event or opportunity coming up that you'd like to highlight? Email info@aligningforhealth.org to be included in the next newsletter.

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Highlights

Member News

American Hospital Association: (12/15) - The American Hospital Association submitted comments to the CMS Innovation Center in response to its strategic refresh, which included a recommendation that risk adjustment models should take into account patients’ social needs and SDOH that are beyond clinicians’ control but that significantly impact outcomes.

Vizient: (12/15) - Vizient recently held its Vizient Connections Summit, with several themes of unity and connection running through the event. One such theme was that between connection and health equity, and that addressing health equity means developing a deep understanding of the personal connection between the role of the health system and the local community it serves.

CareSource: (12/14) - CareSource partnered with Hocking Athens Perry Community Action (HAPCAP) to provide kitchen kits for holiday meal preparation. Residents of seven southeast Ohio counties received boxes including fresh produce and other cooking essentials, with over a thousand families benefiting from the holiday mobile market program.

Echo Press: (12/10) - PrimeWest Health and Unite Us have partnered to expand a secure, coordinated care network called Unite Minnesota to address unmet needs of people across the state. The network will include five counties at first, and then will expand to other counties across the state by summer 2022.

PR Newswire: (12/9) - Unite Us is partnering with Bento, a service that addresses food insecurity in California through a patient engagement platform. The platform connects individuals and families with nutritiously curated, prepaid meals from restaurants and grocery stores via text messages. The partnership aims to address rising rates of food insecurity across the US.

White House: (12/7) - In response to Vice President Harris’ Call to Action to improve maternal health outcomes across the US, several organizations have made external contributions to kick off this work and the White House Maternal Health Day of Action. This includes a partnership between Blue Cross Blue Shield Association and March of Dimes to advance health equity outcomes for moms and babies in an initiative called “Awareness to Action: Dismantling Bias in Maternal and Infant Healthcare.” This also includes a partnership between Lyft and CareSource to conduct analysis on the impact that safe, reliable transportation has on healthy pregnancies.

Health Payer Intelligence: (12/3) - Blue Cross Blue Shield of Massachusetts, a health plan of Blue Cross Blue Shield Association, is providing $25 million to local health care organizations to reduce racial care disparities. These funds will help recipients improve equity efforts and offer financial incentives for addressing inequities in new contracts starting in 2023.

Legislative Roundup

Kaiser Family Foundation: (12/16) - The Build Back Better Act (BBB) includes several provisions aimed at improving maternal health, particularly for people of color. This issue brief outlines the numerous provisions included in BBB to address maternal health, as well as other efforts underway to improve maternal health by both the federal government and non-governmental organizations.

Homeless Children and Youth Act: (12/14) - Rep. Sherrill (D-NJ) and 10 bipartisan cosponsors introduced the Homeless Children and Youth Act (H.R. 6287), which would amend the McKinney-Vento Homeless Assistance Act to meet the needs of homeless children, youth, and families, and honor the assessments and priorities of local communities. The legislation also makes a fix to align the definition of homelessness across federal agencies to improve access to services and assistance, and to help communities and organizations pursue strategies to reduce homelessness.

Protect Black Women and Girls Act: (12/14) - Reps. Kelly (D-IL), Clarke (D-NY), Fitzpatrick (R-PA), and Watson Coleman (D-NJ) introduced the Protect Black Women and Girls Act (H.R, 6268), which would establish an Interagency Task Force to examine the conditions and experiences of Black women and girls in education, economic development, healthcare, labor and employment, housing, justice and civil rights, to promote community-based methods for mitigating and addressing harm and ensuring accountability, and to study societal effects on Black women and girls.

Food Donation Improvement Act: (12/13) - Reps. McGovern (D-MA), Newhouse (R-WA), Pingree (D-ME) and Walorski (R-IN) introduced the Food Donation Improvement Act of 2021 (H.R. 6251), which would amend the Bill Emerson Good Samaritan Food Donation Act to clarify and expand food donation. Specifically, the bill would address food insecurity and encourage food donation efforts by extending liability protections to food donors when food is either given directly to a person in need or when a recipient pays a deeply reduced cost. Sens. Blumenthal (D-CT) and Toomey (R-PA) introduced companion legislation in the Senate (S. 3281).

Improving Coordination for Healthy Moms Act: (12/9) - Sens. Warnock (D-GA) and Rubio (R-FL) introduced the Improving Coordination for Healthy Moms Act (S.3362), which would establish a formal coordinated approach for monitoring maternal health efforts across the Department of Health and Human Services.

CARING for Social Determinants Act: (12/8) - The House passed in a vote of 378 – 48 the CARING for Social Determinants Act of 2021 (H.R.3894). The bill requires the Centers for Medicare & Medicaid Services to periodically update specified guidance to help states address social determinants of health (e.g., socioeconomic factors) under Medicaid and the Children's Health Insurance Program (CHIP). The bill now goes to the Senate for consideration.

Rep. Adams: (12/7) - In a recent editorial, Rep. Adams (D-NC) reflected on the White House’s Maternal Health Day of Action Summit. In her remarks, she outlines how the Black Maternal Health Momnibus provisions included in the Build Back Better Act will save lives and improve outcomes across the country.

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

CMS: (12/14) - CMS is encouraging hospitals to implement evidence-based patient safety practices for managing obstetric emergencies along with interventions to address other key contributors of maternal health disparities. In support of delivering equitable, high-quality maternity care, CMS encourages hospitals to review their policies and procedures for incorporation, where appropriate, of best practices. HHS press release

PTAC: (12/9) - The Physician-Focused Payment Model Technical Advisory Committee (PTAC) sent a report to HHS Secretary Becerra containing comments and recommendations on optimizing efforts to address social determinants of health and equity in the context of alternative payment models (APMs) and physician-focused payment models. The report also identifies where additional research is needed and next steps for policymakers.

HHS: (12/9) - HHS Secretary Becerra launched the Biden-Harris Administration’s White House Initiative on Asian Americans, Native Hawaiians, and Pacific Islanders (WHIAANHPI) and announced U.S. Trade Representative Ambassador Katherine Tai as his co-chair of both the White House Initiative and the President’s Advisory Commission. The Initiative includes an Interagency Working Group tasked with coordinating the federal government’s efforts to support Asian American, Native Hawaiian, and Pacific Islander communities. It also includes a Regional Network composed of federal officials in ten federal regions across the country who help to connect AA and NHPI communities with federal grants, programs, and resources.

HHS and HUD: (12/8) - HHS and the U.S. Department of Housing and Urban Development (HUD) announced the expansion of a partnership established earlier this year to improve access to affordable, accessible housing and the critical services that make community living possible. The partners also announced the launch of a national Housing and Services Resource Center (HSRC) as the hub of this coordinated federal effort.

HHS: (12/8) - HHS, through the Health Resources and Services Administration (HRSA), awarded approximately $82 million in American Rescue Plan (ARP) emergency home visiting funds for the Maternal, Infancy and Early Childhood Home Visiting (MIECHV) program to 56 states, jurisdictions, and nonprofit organizations to support children and families affected by the COVID-19 pandemic.

CMS: (12/7) - CMS released guidance to states on Sections 9812 and 9822 of the American Rescue Plan Act of 2021, which gives states a new option to provide 12 months of extended postpartum coverage to pregnant individuals enrolled in Medicaid and CHIP beginning April 1, 2022.

White House: (12/7) - Vice President Harris issued a nationwide Call to Action to both the public and private sectors to reduce maternal mortality and morbidity. As part of the call to action, the Administration will pass the Build Back Better Act, which includes a $3 billion investment in maternal health, encourage states to expand postpartum coverage, report on the impact of postpartum coverage, and create a new designation of the quality of maternal health services for our nation’s hospitals.

HHS ASPE: (12/7) - The HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) issued a report examining the role Medicaid plays in postpartum maternal health, reviews states’ existing pregnancy-related Medicaid eligibility limits, and assesses the projected eligibility impact if all states were to provide 12 months of postpartum Medicaid eligibility. ASPE found that one in three pregnancy-related deaths occur between one week and one year after childbirth, and disruptions in postpartum health coverage are common, particularly among those enrolled in Medicaid. In addition, ASPE determined that if all states extended pregnancy-related Medicaid eligibility to 12 months postpartum, the proportion of pregnant Medicaid beneficiaries who would remain eligible for the full postpartum year would increase from 52 percent to 100 percent, representing approximately 720,000 people annually with expanded coverage.

CMS: (12/7) - CMS – as part of Vice President Harris’ Call to Action to reduce maternal mortality and morbidity – announced steps to improve maternal health and support the delivery of equitable, high-quality care for pregnancy and postpartum. CMS intends to propose a “Birthing-Friendly” designation to drive improvements in perinatal health outcomes and maternal health equity. In addition, and in response to a recent ASPE report on Medicaid postpartum coverage, CMS is encouraging states to take advantage of the American Rescue Plan’s (ARP’s) option to provide 12 months postpartum coverage to pregnant individuals who are enrolled in Medicaid or CHIP. HHS press release HHS actions to improve maternal health outcomes

NIH: (12/7) - The National Institutes of Health (NIH) announced up to $1 million in cash prizes for innovative diagnostic technologies to help improve maternal health around the world in conjunction with the White House “day of action” on maternal health. The NIH Technology Accelerator Challenge (NTAC) for Maternal Health will seek to spur and reward the development of prototypes for low-cost, point-of-care molecular, cellular, and/or metabolic sensing and diagnostic technologies.

HUD Exchange: (December 2021) - The Department of Housing and Urban Development (HUD) published its COVID-19 Homeless System Response: Vaccine Planning and Distribution resource page, which lists documents developed by HUD technical assistance providers in partnership with federal partners and subject matter experts on vaccine access for homeless services providers and individuals experiencing homelessness.

AFH Reflects on Progress Made on SDOH in 2021

As 2021 draws to a close and we look towards 2022, Aligning for Health reflects on the incredible foundation laid by policymakers this year to improve health and wellbeing for all by creating opportunities and lowering barriers to addressing social determinants of health (SDOH). Read our new blog post highlighting the major progress made this year both in Congress and the Biden-Harris Administration on advancing policies aimed at addressing SDOH.

Read Blog

SDoH & Health Equity in the News

Center for Health Care Strategies: (12/16) - The Texas Managed Care Organization Social Determinants of Health Learning Collaborative has been working with Texas Health and Human Services Commission (HHSC) and Texas Medicaid MCOs for two years to support implementation of strategies that address unmet health-related social needs for Medicaid enrollees. This article highlights key takeaways from an interview with two HHSC officials on Texas’ strategy to address unmet health-related social needs in the Medicaid program.

Health Affairs: (12/16) - In Part Two of the Health Affairs “Value Assessment: Where Do We Go Post-COVID?” Series, Anish Mahajan discusses the challenges concerning health-related social needs within the Medicaid program. Mahajan discusses screening for and resolving health-related social needs in Medicaid, aligning available social services capacity with social services need, and addressing community-level social inequality as the key challenges in this work, citing the need for effective and coordinated transformation at programmatic, regulatory, delivery system, and social sector levels to address such challenges.

Business Insider: (12/15) - Through its UnitedHealthcare Catalyst program, UnitedHealthcare is working with select partners in over two dozen communities to close gaps in health care and address health equity challenges. The program, through collaborative partnerships and anonymous data sharing, is designed to expand access to health care to address each community’s needs, and bring the right partners together to align primary and behavioral health with social needs to improve health outcomes and drive equitable care.

Becker’s Hospital Review: (12/14) - More than 70 organizations have signed the Digital Health Equity Pledge, which was launched by the Executives for Health Innovation. The purpose of the pledge is to advance digital health equity and to ensure digital health technologies do not exacerbate existing biases and inequities through four principles: accessibility, diversity, respect and public policy.

The New York Academy of Medicine: (12/14) - The New York Academy of Medicine (NYAM) and the New York City Department of Health and Mental Hygiene launched Health Data for New York City (HD4NYC) in 2019, which produces data-driven research to directly inform policies and programs to address health inequity in NYC. The initiative, which brings together cross-sector working groups and streamlines access to data from the Health Department and other NYC agencies, recently released new data that is spotlighted in this article and the Journal of Urban Health.

My Wabash Valley: (12/14) - Illinois Governor JB Pritzker signed House Bill 3401 into law, which allows for licensure and certification of midwives in the state of Illinois and is aimed at reducing maternal health issues across the state. The bill will create the Licensed Certified Professional Midwife Practice Act, which licenses people who perform out-of-hospital births and have earned credentials to be a midwife.

PCORI: (12/13) - The Patient-Centered Outcomes Research Institute (PCORI) announced its proposed research agenda which prioritizes research on health equity, stakeholder engagement, health outcomes, and social determinants of health. Among its focus areas include research that aims to achieve health equity and eliminate health care disparities, and research that focuses on health promotion and illness prevention by addressing health drivers that occur where people live, work, learn and play.

Tap Into Somerville: (12/13) - Rutgers University is launching a new initiative to improve the health of economically disadvantaged communities dealing with food insecurity and other social determinants of health. With the help of a $10 million grant from the Robert Wood Johnson Foundation, Rutgers will launch the Rutgers Equity Alliance for Community Health (REACH) to work alongside community-based organizations on new approaches to achieve health equity and bring about long-lasting, systemic change.

Business Wire: (12/13) - UnitedHealthcare Community Plan of California announced a $1.5 million investment in community-based programs aimed at reducing health disparities and improving equity in San Diego. The health plan will collaborate with local organizations to target specific population health issues, such as housing and homelessness, and to address specific health needs of underserved members of the community facing gaps in access to care.

Medscape: (12/13) - At a recent Institute for Healthcare Improvement event, Jann Murray-Garcia, MD, MPH, director of social justice and immersive learning at UC Davis Moore School of Nursing, discussed how medical professionals can help address racial disparities in the health care system. She pointed to the “scripts” that guide a health care practitioner’s approach to caring for patients, and that often these scripts are what result in inadequate outcomes for patients of color.

Health Leaders: (12/7) - At the recent Institute for Healthcare Improvement (IHI) forum, two of its leaders highlighted predictions for a movement toward outcome-based measurement for health equity in 2022. This will likely include “guidance around outcomes stratification using race, ethnicity, language, disability, sexual orientation and gender identification,” in addition to stratifying measures of outcomes on such dimensions, according to IHI President and CEO Kedar Mate.

Milbank Memorial Fund: (12/6) - The State of California recently used principles of health equity in its response to the COVID-19 pandemic. This blog highlights two important new developments by the state to advance health equity: legislation to establish a health equity fund, and MediCal waivers to address health equity.

Health Payer Intelligence: (12/2) - CVS Health recently announced it would invest $9.2 million in affordable housing in Washington, DC to provide 41 affordable housing units to families in the district. This is part of an ongoing initiative to address racial equity and social determinants of health by the company.

The Hill: (12/2) - In this op-ed, R. Lawrence Moss, President and CEO of Nemours Children’s Health, and Stacey Stewart, President and CEO of March of Dimes, discuss how legislation around maternal and child health must be prioritized in Congress. The op-ed outlines the many policies currently introduced that Congress should pass now, including the maternal health provisions in the Build Back Better Act, the Maternal Health Quality Improvement Act, and the Black Maternal Health Momnibus.

Bipartisan Policy Center: (12/1) - In this blog, authors discuss how improving the quality of affordable housing is just one step toward supporting healthy communities and advancing health equity. The Center for Active Design (CfAD) has worked to set a standard for healthy housing through design and development practices, and works with actors across the real estate industry to implement the Fitwel Certification System as a framework for optimizing health within commercial and residential buildings and sites as part of its strategy to incentivize inclusive, equitable mixed-income communities designed for health.

New Research and Reports

Families USA: (12/16) - Families USA published a new road map that offers a framework for state Medicaid programs to scale up and fund evidence-based home visiting (EBHV) programs to improve outcomes for mothers and their children. The road map outlines options and highlights existing state examples for Medicaid programs to fund EBHV services, from small-scale quality improvement efforts to robust value-based purchasing strategies.

Patient Engagement HIT: (12/15) - A study from the University of Chicago Medicine, Lawndale Christian Health Center, and Chicago Department of Public Health found that housing security was associated with a significant decrease in COVID-19 infection among high-risk people experiencing homelessness. Researchers found that individuals experiencing homelessness who were also at an increased risk for the virus were less likely to contract it if they were provided individual hotel rooms, medical support, and social support compared to the citywide rates in a homeless shelter.

NEJM Catalyst: (12/15) - This study looked at components of the Flexible Services Program in Massachusetts, which allows the state’s Medicaid ACOs to pilot evidence-based initiatives that address a member’s health-related social needs in order to improve health outcomes and reduce total cost of care. Examining payment mechanisms established in partnership between the ACOs and social service organizations, combined with interviews with leaders of ACOs, revealed both strengths and challenges to be addressed.

NEJM Catalyst: (12/15) - Given the inequities exposed and intensified by COVID, the authors of this brief describe the response of a community health center that serves a largely Latinx population. Brookside Community Health Center adapted and redesigned health care to better address SDOH and their drivers.

Together for Better Medicaid: (12/14) - Together for Better Medicaid released a report on the potential for Medicaid managed care organizations to assist states in addressing social determinants of health and health equity. The report identified several trends in how MCOs are addressing SDOH requirements from the state, including requiring MCOs or provider networks to screen enrollees for social needs or requiring SDOH to be included in care management programs, among others.

NASHP: (12/13) - This brief from the National Academy for State Health Policy (NASHP) highlights the work of nine states to prevent and mitigate adverse childhood experiences (ACEs) and to implement trauma-informed practices at the state level. States are implementing holistic approaches to promoting resilience for children and their families and adopting approaches that combine universal training, access to screening and treatment, improved data collection and reporting, and a commitment to transformative, cross-agency cultural change.

NASHP: (12/10) - Community Health Worker (CHW) is an umbrella term that encompasses several categories of frontline public health workers, who are often trusted members of the community and help facilitate care coordination with health and human services providers and address social determinants, among other roles. This map identifies state approaches for Medicaid reimbursement of CHW services, and the accompanying chart provides details about other ways that states are supporting a CHW workforce.

Patient Engagement HIT: (12/9) - New research from the Robert Wood Johnson Foundation and RAND Corporation found that the number of people who think health disparities and inequities are a problem has waned since 2020. RWJF researchers saw a decline in the number of people recognizing health disparities between July 2020 and September 2021, with 61.1 percent of adults agreeing people of color faced a disproportionate health impact from COVID in July compared to 52.7 percent in September 2021.

Kaiser Family Foundation: (12/9) - The use of race to inform clinical diagnoses and decision making may reinforce disproven notions of race as a biological construct and contribute to ongoing racial disparities in health and health care. This brief provides an overview of the role of race in clinical care and discusses the implications for health and health care disparities and efforts to advance health equity.

Bipartisan Policy Center: (12/7) - There is a need to address the stark racial and ethnic disparities in housing in the US, in order to strengthen families and communities. This paper highlights these disparities as the basis for charting a viable path forward and catalogs some of the most striking disparities in housing to advance bipartisan policies to close these gaps.

Journal of Primary Care & Community Health: (December 2021) - Many health systems screen patients for social determinants of health and refer patients with social needs to community service organizations for assistance. The researchers behind this study developed a framework based on sequential steps to evaluate this process of screening and assistance steps for over 5,000 patients who attended a COVID vaccine clinic in early 2021. Of the 360 referrals accepted by community organizations, 98 (or 27 percent) were resolved.

Health Affairs: (December 2021) - This study of patients at a major academic medical center explored how recruitment and enrollment approaches affected the demographic diversity of participants in its research biospecimen and data bank. The work underscored the need for systemic commitment to diversify data banks so that different communities can benefit from research, as patients who consented to enroll in the research data bank were significantly less diverse in terms of age, sex, race, ethnicity, and socioeconomic status.

Health Affairs: (December 2021) - This study looked at sociodemographic disparities in COVID-19 vaccine access upon rollout at Publix grocery store locations throughout Florida in January 2021. The study found strong associations between the number of vaccination sites in a zip code and race and ethnicity and a weaker association with percentage of residents at or below the poverty level, indicating a need for vaccine distribution to be monitored through a sociodemographic lens to prevent unequal access.

Data and Innovation

MedCity News: (12/15) - Issues related to technology during the pandemic led to access issues in communities across the nation, sometimes leading to a tech gap or “digital divide,” particularly among seniors. This article proposes four priorities for solutions to address this divide and close the technology gap, including equipping seniors with tools, training and access to use technology, and empowering patients to receive care in a manner that works best for them and to give them health data that puts them at the center of their care.

Health Leaders: (12/15) - Children’s Mercy Hospital of Kansas City is testing out a new decision support tool that addresses social determinants of health. The Envirome Web Services provides personalized SDOH data for each patient in the health system’s electronic health records, where it securely geocodes patient addresses in real time to link their records with publicly available contextual data, while giving clinicians summaries of the data without interrupting their workflows with additional alerts.

American Medical Association: (12/13) - Marshfield Clinic Health System has a plan to advance health equity by screening for social determinants of health and connecting patients with community-based agencies who will provide them with social services. This work requires data and a universal information technology system that can access or enter that data from any of the health system’s 60 locations and from the community organizations with which they partner. This article explains more behind this approach.

Modern Healthcare: (12/7) - The Black Equity Coalition is a grassroots collaboration that scrapes government data and shares community health intel. During the pandemic, a dozen members of its data team of 60 met twice weekly to study hospitalization rates and employment statistics, and found that black residents in Allegheny County saw disproportionate hospitalization rates, and were more likely to land in the ICU or on a ventilator during the pandemic.

American Journal of Preventive Medicine: (12/2) - Health-related social needs are known drivers of health and health outcomes, yet work to date to examine health-related social needs using ICD-10 Z codes remains limited. This study seeks to evaluate the differences in the prevalence of conditions as well as utilization and cost between patients with and without health-related social needs.

Upcoming Events

January

January 12 - Systems for Action, “COVID’s Impact on Health Equity and Access to Health & Social Services: A Conversation Across the RWJF For Action Programs.” Virtual.
January 13 - AHIP, “Why SDOH Insights are Critical to Care Quality.” Virtual.
January 25 - US News & World Report, “Measuring Health Equity: Building a US News Health Equity Index for Hospitals and Health Systems.” Virtual.
January 26 - Systems for Action, “Using Regional Governing Boards to Align Services for Rural Children of the Opioid Crisis.” Virtual.
January 27 - CodeX, “Leveraging Interoperability to Drive Health Equity in Cancer Care, Research and Surveillance.” Virtual.

February/March

February 16 - Systems for Action, “Multisector Task-Sharing to Improve Mental Health in Harlem, NY.” Virtual.
March 2 - Systems for Action, “Social Bonds as a Pooled Financing Mechanism to Address Social Drivers of Health Equity.” Virtual.
March 22 - Systems for Action, “Integrating Health and Social Services through a Novel Independent Practice Association.” Virtual.

SDoH Opportunities

Request for Collaboration

The Food as Medicine Collaborative in San Francisco is looking to evaluate the impact of their Food Pharmacy program on the clinic staff who coordinate it. Does your organization provide medically-supportive food and nutrition interventions (i.e. produce prescriptions, medically tailored meals, food pharmacies, etc.) and have you received feedback from clinic staff? If so, please reach out to efraney2@jhmi.edu

December