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Social Determinants Updates

June 13 through June 26, 2020

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

In this newsletter you will find updates on how the health care system is helping to meet health and social needs during the current public health emergency, notable links to research, data, and news related to health disparities and social determinants, and upcoming virtual events and opportunities.

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Member News

Health Payer Intelligence: (6/26) – Although chronic disease contributes to higher health care costs, payers, including HCSC, are employing strategies to improve health outcomes, such as preventive care strategies that address social determinants of health.

Centene:(6/25) – Centene highlights how their health plans have continued to partner with local nonprofit organizations to meet the non-medical needs of the communities they serve during and beyond the pandemic.

Metro Atlanta CEO: (6/24) – The CareSource Foundation announced a donation of $180,000 for the RESTORE ATL Fund created by the Metro Atlanta Chamber, which supports black-owned small and medium-sized businesses impacted by the COVID-19 pandemic.

Nebraska ABC: (6/22) – Unite Us and the Nebraska Health Information Initiative have begun a collaborative effort to bring patients’ clinical and social health together on one portal in the Nebraska health information exchange.

AJMC: (6/21) – Speaking at AHIP’s Institute & Expo Online, UPMC discussed how data partnerships can reduce barriers to access and improve outcomes in health care with greater collaboration of health insurance providers with state and county leaders.

Fierce Healthcare: (6/19) – Unite Us has acquired social determinants of health-focused analytics company Staple Health, expanding their data capabilities and expanding access to data on outcomes and provider capabilities.

CareSource: (6/18) – CareSource joined 33 other organizations in asking senators and representatives to address housing instability in the next coronavirus relief package and announced their intention to intensify their commitment to support housing stability in Indiana during COVID-19.

Ritz Herald: (6/16) – Centene and Sunshine Health are partnering with organizations across Florida to support efforts that address social determinants of health like food, internet connectivity, and essential supplies.

Becker’s Hospital Review: (6/16) – Cleveland-based Metro Health has integrated Unite Us’ electronic resource referral platform within its EHR to better track and coordinate resources for patients’ social determinants of health needs.

Managed Healthcare Executive: (6/15) –COVID-19 has taken a deadly toll on the African American community, with Amida Care CEO Doug Wirth commenting that hospitals in low-income neighborhoods were overwhelmed with cases and also experienced the most severe equipment shortages.

AHA Center for Health Innovation: (6/9) – American Hospital Association released a newsletter on how stakeholders are targeting health disparities during the COVID-19 pandemic, highlighting hospitals, health systems and various stakeholders that have been working together to share data and develop solutions.

Social Determinants Accelerator Act – Recent Updates

New Cosponsors

Over the past two weeks, the Social Determinants Accelerator Act (H.R. 4004) has gained 13 cosponsors in the House, bringing the total number of bipartisan cosponsors up to 38.

Dear Colleague Letter

Representative Cheri Bustos (D-IL) the lead House sponsor of the Social Determinants Accelerator Act (H.R. 4004), sent out a Dear Colleague letter to co-sign the bill, linked here.


In response to the Ways & Means hearing on the disproportionate impact of COVID-19 on communities of color, the American Medical Association, American Academy of Family Physicians, and American Association of Medical Colleges all recommended that Congress enact SDAA as one way to help address health disparities.

SDoH in the News

The Hill: (6/24) – The author of this op-ed calls for support for the Black Maternal Health Momnibus Act (H.R. 6142), which would help reverse health disparities in maternal mortality, given that black women in the U.S. are three to four times as likely to die due to pregnancy-related causes as compared with white women

Revcycle Intelligence: (6/23) – According to CMS, health disparities seen in Medicare claims data during the COVID-19 crisis underscore the need to transition to value-based reimbursement models, which encourage clinicians to provide whole-person care.

Patient Engagement HIT: (6/23) – In this article, Patient Engagement HIT outlines some of the key social determinants of health that affect chronic disease management and how the healthcare industry has begun to address them.

Health Payer Intelligence: (6/22) – Humana’s latest Bold Goal program report highlights ways that payers can scale their social determinants of health strategies across lines of business and demographics.

NASHP: (6/22) – During the COVID-19 pandemic states have begun engaging community health workers to combat COVID-19 and health inequities given their unique position as culturally competent, frontline public health workers who are trusted by the communities they serve.

St. Louis American: (6/22) – Contact tracing efforts in St. Louis have allowed investigators to meet unmet health and social needs beyond the pandemic by working with the Integrated Health Network, Regional Health Commission, health centers, hospital systems, and the Urban League to identify resources that may be available but unknown to uninsured individuals.

Route Fifty: (6/19) –Virginia’s Health Equity Task Force is pursuing partnerships with local governments in order to get protective gear and information about COVID-19 to minority communities, using Census data to identify communities with characteristics that may put households at increased risks.

CNBC: (6/19) – African American doctors are pushing for anti-bias training in medicine to combat health inequalities, including lectures on social determinants of health, as research has shown that the lack of diversity can translate into less-responsive care for people of color.

HIT Consultant: (6/18) – Social determinants of health options are beginning to be factored into health coverage benefit offerings, with plans beginning to see the benefit of addressing social needs in addition to health needs.

Forbes: (6/18) – Humana’s Bold Goal initiative to improve the health of seniors in private Medicare plans through better management of patient populations continues to show improvement five years into the effort, with an improvement in the number of healthy days among all MA members across all markets.

Patient Engagement HIT: (6/17) – The Department of Veterans Affairs announced a partnership with Feeding America to provide over 710,000 meals to veterans as part of the VA’s efforts to address social needs.

Forbes: (6/17) –In order to mitigate a second wave of COVID-19, the United States has to prioritize social determinants and focus on prevention instead of addressing health problems after they manifest.

Patient Engagement HIT: (6/16) – While community health and community-based health are two related population health strategies, they have inherently different delivery mechanisms with community health focusing on multi-sector and multi-disciplinary collaboratives that promote healthy living and addressing social needs.

Patient Engagement HIT: (6/16) –68 percent of primary care patients think that racism is affecting their health according to a new survey from the Larry A. Green center and the Primary Care Collaborative, which underscores racism as a key public health issues and race as a social determinant of health.

MedCityNews: (6/15) – This article argues that COVID-19 has shed a light on the need for widespread interoperability, which would allow for expanded analyses covering all patient information, including social needs, care disparities, preexisting conditions and patient history.

Modern Healthcare: (6/13) – COVID-19 highlights the need to tackle lingering social needs, with the urgency of finding upstream solutions becoming more crucial as the impact of COVID-19 on many communities affected by social determinants of health.

CHCS: (June 2020) – CHCS features the work of Dr. Norm Ward, a family practitioner and Chief Medical Officer for OneCare Vermont and the need to use online data tools to connect high-risk patients with social needs to resources when in-person visits are not possible.

City Health Dashboard: (June 2020) – NYU’s City Health Dashboard has launched a new COVID-19 Local Risk Index, which enables municipal leaders to identify cities and neighborhoods with populations at higher risk of COVID-19 infection or severe illness by incorporating key risk factors that are social determinants of health.

New Research and Reports

Patient Engagement HIT: (6/25) – New research in JAMA finds that patient literacy and knowledge about COVID-19 falls along sociodemographic lines, furthering evidence that social determinants of health dictate an individual’s ability to stay healthy.

Patient Engagement HIT: (6/24) –Limited access to care and the impact of social determinants of health have led to health disparities and increased COVID-19 spread in Latinx populations in Maryland, according to research from Johns Hopkins University.

RAC Monitor: (6/24) – A new national survey led by researchers from Northeastern, Harvard, Northwestern and Rutgers Universities sheds light on the current impact of COVID-19 and the growing concerns over health disparities associated with the social determinants of health and social determinants of mental health.

Health Affairs: (6/22) – This research brief includes a literature review linking social isolation to mortality and evidence supporting the existence of biological and behavioral pathways that social isolation and loneliness effect. The authors also provide policy recommendations and offer guidance on awareness, education and national guidelines.

PubMed: (6/22) – A systematic literature review of the cost-effectiveness of interventions leveraging social determinants of health to improve screening for breast, cervical and colorectal cancer, find that the median intervention cost per participant was $123.87. The increased screening rates were associated with earlier diagnosis and treatment and in improved health outcomes.

Health Affairs: (6/22) – Social isolation is a significant contributor to morbidity and early mortality, with this brief urging greater prioritization of intervention science and policy to adequately address the public health burden of social isolation.

Forbes: (6/16) – A new CDC report summarizes the stark differences in how COVID-19 impacts different populations, with evidencing showing coronavirus disproportionately affects those with underlying disease and disadvantaged minorities.

Health IT Analytics: (6/11) – With increasing evidence of the interconnectedness of COVID-19 morbidity and mortality with social determinants of health, researchers from the Columbia Mailman School of Public Health note that health systems should target population health interventions to these high-risk patients and communities.

Journal of Aging and Social Policy: (6/9) – Co-authored by the National Association of Area Agencies on Aging, Scripps Gerontology Center at Miami University, and Berkeley School of Public Health, this study examines factors that contributed to the ability of AAA’s to execute a dynamic response and how AAA’s are positioned to be key partners in health systems.

SIREN: (June 2020) – An evaluation of Connect for Health, a social referral program in Rhode Island found that the structured program for referral services alleviated some patient needs and provider workloads, bud fundamental socioeconomic disparities and inadequate resources limit effectiveness.

Aging and Disability Business Institute: (June 2020) – Providing an overview of key themes emerging from a stakeholder meeting in 2019, this report highlights the state of CBO-health care contracting and provides recommendations for future collaboration.

SIREN: (June 2020) – A study evaluated the impact of an on-site versus remote patient navigator for pediatrician referrals and families’ receipt or resources for unmet social needs, indicating that clinicians were more likely to refer families to patient navigation if the navigator was on-site.

SIREN: (June 2020) – A care coordination program designed to reduce utilization among high-cost, high-need Medicaid beneficiaries was associated with fewer ED visits and hospitalizations for patients with diabetes in selected Medicaid programs that were evaluated, but not others.

SIREN: (June 2020) – A Milbank Memorial Fund study analyzed policy levers employed by states through their Medicaid ACOs to incorporate requirements and incentives for ACO providers to address social determinants of health.

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