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.
Blue Cross Blue Shield Association: (10/28) - Blue Cross Blue Shield Association (BCBSA)
President and CEO Kim Keck issued a statement on the White House’s Build Back Better Act framework. Keck was pleased to see provisions to make health care more affordable, equitable and accessible, and reaffirmed BCBSA’s commitment to working with Congress to improve health equity,
GlobeNewswire: (10/27) - Healthy Alliance IPA, an affiliate of the Alliance for Better Health, and Unite Us announced they are expanding the reach and coordination of critical social services across the State of New York. The partnership will convene regional community leaders and thousands of local community-based organizations across the state to ensure New Yorkers have access to a comprehensive, coordinated social care service network.
Tribune Live: (10/27) - During the latest episode of the Food Podcast on the TribLIVE podcast network, Greater Pittsburgh Community Food Bank talks with UPMC Health Plan about its efforts to address food insecurity. UPMC Health Plan works with the food bank to provide food to patients through an innovative team, created to help the welfare of the UPMC Health Plan member community.
Citizen Tribune: (10/26) - A Health Evolution Forum work group has been convening to develop a consistent set of measures and approaches to collecting, stratifying and analyzing disparities data. Approximately 40 leading organizations, including the Blue Cross Blue Shield Association (BCBSA), have signed the corresponding Health Equity Pledge, committing to collect data about race, ethnicity, language, sex (REaLS) and share what they learn to develop best practices that are ultimately disseminated broadly across the industry.
American Hospital Association: (10/25) - During the latest episode of American Hospital Association’s (AHA)Leadership Rounds, AHA Chair Rod Hochman, MD speaks with Maureen Bisognano of the Institute for Healthcare Improvement (IHI) on health care equity, quality and workforce. Maureen talks about IHI’s breakthrough approach to change using data and storytelling, and explains the Institute’s work to build the will for change and close gaps in health care access, quality and outcomes.
3M: (10/21) - In this episode of the 3M Inside Angle podcast, William Bleser, PhD at Duke Margolis Center for Health Policy, digs into the details of value-based payment models that are working to address social determinants of health, bringing to light key strategies for successful payment reform and pitfalls to avoid.
CareSource: (10/18) - Many CareSource members have faced a lack of reliable transportation as a barrier in receiving the COVID-19 vaccine. To address this, CareSource launched a pilot program to improve access to COVID-19 vaccinations for individuals lacking a source of consistent transportation or those unable to safely leave their homes to be vaccinated by bringing the vaccine to their homes.
Public Exchange: (October 2021) - In partnership with findhelp.org (formerly Aunt Bertha) and other partners, the Los Angeles County Emergency Food Security Branch prepared a report to examine the impact of COVID-19 on food insecurity and access, and the food environment in LA County, from April 2020 through September 2021. The report outlines findings to inform LA County’s ongoing efforts to raise awareness of financial and food assistance resources for residents in need, and includes recommendations from the first 18 months of the pandemic to strengthen food systems in LA County.
House Rules Committee: (10/28) - The House Rules Committee released its preliminary draft of the Build Back Better Act, which the Committee is reviewing in preparation for a full House vote on the language. Notably, the text included every eligible provision of the Black Maternal Health Momnibus, as well as mandatory, permanent investments in year-long postpartum Medicaid coverage in every state. The specific Momnibus provisions included in the text can be found here.
Reaching Every Homeless Veteran Act: (10/27) - Sens. Moran (R-KS), Manchin (D-WV), Sullivan (R-AK), Capito (R-WV), Marshall (R-KS), and Hirono (D-HI) introduced the Reaching Every Homeless Veteran Act of 2021 (S. 2094), which would improve homeless veterans reintegration programs.
White House Conference on Food, Nutrition, Hunger, and Health Act: (10/26) - Sens. Booker (D-NJ) and Braun (R-IN) and Reps. McGovern (D-MA) and Walorski (R-IN) introduced the White House Conference on Food, Nutrition, Hunger and Health Act (S. 3064/H.R. 5724), which would authorize and convene a second national White House Conference on Food, Nutrition, Hunger and Health. The proposed second conference would take a whole-of-government approach to ending hunger and combatting nutrition insecurity, and would feature voices of those with lived experiences. Bill text
Equal Health Care for All Act: (10/26) - Rep. Schiff (D-CA) and 22 cosponsors introduced the Equal Health Care for All Act (H.R. 5742), which would prohibit discrimination in health care and require the provision of equitable health care. The bill would address racial inequities in America’s health care system by making equitable medical care a protected civil right. Senator Padilla (D-CA) introduced companion legislation in the Senate (S. 3073).
Rep. Adams: (10/26) - Reps. Adams (D-NC), Underwood (D-IL), Kelly (D-IL), and Beatty (D-OH) and Sen. Booker (D-NJ) sent a letter to President Biden, Speaker of the House Nancy Pelosi, and Senate Majority Leader Chuck Schumer to ensure that provisions from the Black Maternal Health Momnibus Act are included in full in the final Build Back Better Act package. They also urged the leaders to build on the critical progress made through the American Rescue Plan Act by investing in the permanent expansion of year-long postpartum Medicaid coverage in every state.
Transportation Today: (10/25) - The Congressional Social Determinants of Health Caucus held its first briefing on the role of transportation as a social determinant of health. Caucus Members Reps. Bustos (D-IL), Mullin (R-OK), and Carbajal (D-CA) spoke during the briefing, as did several panelists from a range of sectors on how transportation barriers impact health. Panelists discussed potential solutions to address transportation barriers to improve health outcomes and innovations across the country that could be looked to as examples. A recording of the briefing can be found here.
Social Determinants Accelerator Act: (10/21) - Sens. Young (R-IN) and Stabenow (D-MI) introduced the Social Determinants Accelerator Act of 2021 (S. 3039), which would establish an interagency council on social determinants of health.
Modern Healthcare: (10/19) - Rep. Cheri Bustos (D-IL) penned an op-ed about social determinants of health and how one’s zip code should not determine one’s health or life expectancy. She provides anecdotal stories of how SDOH have impacted her constituents and highlights both the Social Determinants Accelerator Act (H.R. 2503) and efforts underway by the Congressional Social Determinants of Health Caucus as pathways to find solutions to target social determinants and disparities.
Senate Committee on Appropriations: (10/18) - The Senate Appropriations Committeereleased the FY2022 Labor/HHS/Education appropriations bill, which included a number of provisions related to SDOH, health equity, and maternal health. One such provision was $153 million to expand and improve the CDC’s health equity programs through the implementation of SDOH Accelerator Plans. This funding, a $150 million increase from FY2021 appropriation levels, would also support launching an implementation program, and would provide technical assistance to communities that are building the evidence base through improved data collection to better understand health disparities. Bill textExplanatory statementBill summary
To view a full list of the legislation we are tracking around social determinants of health, health equity/disparities, and maternal health, click here.
Senators Young and Stabenow Reintroduced the Social Determinants Accelerator Act!
On October 21, Senators Young (R-IN) and Stabenow (D-MI) reintroduced the Social Determinants Accelerator Act of 2021 (S. 3039). This bill would provide planning grants and technical assistance to state, local, and Tribal governments who want to devise innovative, evidence-based approaches to coordinate programs and services to improve health and wellbeing for underserved populations, particularly those with unmet health and social needs. Reps. Cheri Bustos (D-IL), Tom Cole (R-OK), Jim McGovern (D-MA), and Markwayne Mullin (R-OK) introduced the House companion bill earlier this year (H.R. 2503).
CMS: (10/28) - CMS announced the approval of New Jersey’s 1115 New Jersey FamilyCare Comprehensive Demonstration waiver, which will enable an estimated 8,700 postpartum New Jerseyans to maintain their Medicaid coverage for 12 months after the end of pregnancy. The demonstration is aimed at reducing maternal mortality in the state, and will also ensure the state can receive the enhanced funding for expenditures related to eligible people who remain covered through the demonstration and who would otherwise qualify for the Medicaid expansion population.
Yale School of Medicine: (10/27) - The Food and Drug Administration’s Office of Minority Health and Health Equity (OMHHE) awarded Yale School of Medicine $3 million to promote clinical trial education, awareness, and access for underrepresented minority populations. The project will focus on understanding factors that contribute to morbidity and mortality in racial and ethnic minority populations, including COVID-19, and understanding ways to amplify linguistically and culturally appropriate information related to COVID-19 research awareness and participation.
CMS: (10/20) - CMS released a white paper detailing the vision for the CMS Innovation Center over the next 10 years, titled “Driving Health System Transformation – A Strategy for the CMS Innovation Center’s Second Decade.” The goal of the strategy is to achieve equitable outcomes through high-quality, affordable, person-centered care, carried out through five strategic objectives: Drive Accountable Care, Advance Health Equity, Support Innovation, Address Affordability, and Partner to Achieve System Transformation.
HHS ASPE: (10/20) - HHS ASPE issued a resource guide for providers working with American Indian/Alaska Native people reentering their communities from incarceration, containing a compilation of federal resources, research, examples, and helpful considerations for facilitating a successful reentry.
White House: (10/19) - President Biden signed an Executive Order to establish the White House Initiative on Advancing Educational Equity, Excellence, and Economic Opportunity for Black Americans. This Executive Order will advance educational equity and economic opportunity for Black students, families, and communities by focusing on a set of specific policy goals. This is the latest action by the Administration to tackle systemic racism and make investments to rebuild the economy and social safety net. This fact sheet outlines the steps the Biden-Harris Administration has taken to address systemic racism, including improving health outcomes for Black communities and lowering health care costs.
SDoH & Health Equity in the News
Fierce Healthcare: (10/28) - During the recent Fierce Health Payer Summit, Clover Health highlighted how using open networks, or allowing patients to choose any provider participating in Medicare that accepts them, is critical to health equity. This is especially true when thinking about trust, as a patient may prefer to see a provider from their own community or of the same ethnicity.
Health Affairs: (10/26) - The traditional fee-for-service approach to health care has fueled an inefficient system that fails to directly consider health care outcomes. Financial incentives and risk-adjustment approaches used in value-based programs can also penalize doctors and hospitals for caring for historically marginalized patients and others with significant social needs. As such, this article calls on the health care community to set an explicit intention to use payment as a way to eradicate inequities.
Forbes: (10/26) - Barriers in access to transportation cause 3.6 million American adults to miss or delay health care appointments each year. Non-emergency medical transportation (NEMT), a covered benefit in Medicaid and some Medicare Advantage plans, can play a critical role in addressing this. This article discusses how NEMT could be expanded to play a broader role in improving the health of people in underserved communities through value-added beneficiary services.
Health Leaders Media: (10/25) - Medicare Advantage plans are increasingly looking to develop strategies to address SDOH for beneficiaries, including through more supplemental benefits and targeted community partnerships. These strategies are designed to expand payers’ whole-person care capabilities and credibility. This article highlights three of the largest carriers of MA plans and their efforts to address SDOH for its beneficiaries.
JD Supra: (10/25) - States are increasingly leveraging contracts with Medicaid managed care organizations (MCOs) to address social determinants of health for Medicaid beneficiaries, requiring health plan investment into the community being served by the plan. This article describes the context for these requirements and sample approaches for state Medicaid agencies to integrate community investment strategies into MCO contracts.
Patient Engagement HIT: (10/25) - Iowa-based hospital MercyOne began screening for social risk factors in 2017 largely due to a push from providers who noted the role social factors play in overall patient health. These providers advocated for a way to screen for SDOH, eventually deploying its first digital SDOH screening tool to streamline the process by which the health system could ask patients about their social needs and integrate the data into the electronic health record (EHR) of the patient.
Fierce Healthcare: (10/25) - The Physicians Foundation recently released recommendations to address SDOH in patients, highlighting the burdens physicians face when tracking social determinants. For starters, screening for SDOH in patients has not been built into the workflow, with existing structures serving as a barrier. The data also do not tend to live within the electronic health record, but rather in siloed databases or social service systems. This article outlines other challenges providers often cite in tracking social risk factors of the patients they serve.
Fierce Healthcare: (10/25) - The National Organization for ACOs (NAACOS) released a white paper outlining key recommendations on how CMS can use ACOs to help close equity gaps. CMS has stated that it wants ACOs to gather more data on the race and ethnicity of patients, but has not laid out guidelines on how to tackle equity in value-based care. NAACOS looks beyond this to recommend that ACOs be required to field patient surveys that incorporate equity questions and for CMS to create a new quality measure that addresses health equity at a population health level.
Fierce Healthcare: (10/18) - Startup Papa partnered with Uber Health to make it easier for older adults to get to medical appointments and other events and to run errands. The goal of this partnership is to reduce barriers to transportation access and to mitigate social isolation and negative health outcomes among vulnerable populations.
Fierce Healthcare: (10/18) - At the recent HLTH 2021 conference, hospital system executives from Cleveland Clinic, UMass Memorial Health, and Boston Medical Center discussed the life expectancy rates they are seeing based on zip codes, highlighting the important role social determinants have in overall health outcomes. The health systems discussed the initiatives they are working on to invest more dollars into the communities they serve, through avenues such as affordable housing, grocery stores in food deserts, and more.
Health Affairs: (10/15) - In this episode of the Health Affairs This Week podcast, Michael Lens of the Lewis Center for Regional Policy Studies at the University of California Los Angeles discussed his research on the downstream effects of exclusionary, low-density residential zoning on health and health equity and how low-density zoning relates to health.
New Research and Reports
Kaiser Family Foundation: (10/27) - A new KFF report drawing from findings from the 21st annual budget survey of Medicaid officials found that most states reported the pandemic prompted them to expand Medicaid programs to address SDOH, especially those related to housing. The report contains an entire section devoted to findings around SDOH, providing information about initiatives to address SDOH, efforts to expand the community health worker workforce, initiatives to address disparities in health care by race/ethnicity in Medicaid, and COVID-19 vaccine related MCO initiatives. For example, three-quarters of responding states reported initiatives to address disparities in health care by race/ethnicity in Medicaid, with many focusing on specific health outcomes.
Patient Engagement HIT: (10/26) - Researchers at the American Society for Radiation Oncology reported at their annual meeting that a cancer care delivery model that specifically accounts for SDOH not only improved overall cancer survival rates, but closed racial health disparities in cancer care outcomes. The health care delivery model—which included protocol to flag and address social determinants of health—improved cancer survival rates to 94 percent among both White and Black patients.
Cancer Therapy Advisor:
(10/26) - A survey of US oncologists and hematologists found that such providers have limited time to assist patients with social needs, despite the fact that many patients are impacted by SDOH. Of the respondents, about 51 percent talk to their patients often and 18 percent talk to their patients all the time about how SDOH affects their care. However, 81 percent of respondents said their staff have limited time to assist patients with their social needs and 75 percent said that assistance programs were not readily accessible.
Cato Institute: (10/21) - The Cato Institute’s Project on Poverty and Inequality in California released a report on ways to reduce poverty in the state and strategies for tackling homelessness, as this is a persistent issue facing thousands of Californians. A significant portion of the report focuses on how to resolve high housing costs and the homeless crisis, two issues that are deeply entwined. This article makes the case for how a pro-housing agenda could address the overall cost of housing and cost-effectiveness of resources like supportive housing and shelters.
Kaiser Family Foundation: (10/21) - This brief provides an overview of social determinants of health and a look at how adults are faring across an array of measures as of September 2021 when a portion of the population remained unvaccinated, and hospitalizations and deaths due to the Delta variant were surging in some areas. Large shares of people reported experiencing hardships during the pandemic; for example, more than half (50.9 percent) of adults reported difficulty in paying for usual household expenses in the past seven days. Black and Hispanic adults fared worse than White adults across nearly all measures.
Avalere: (10/19) - Avalere published an analysis finding that more Medicare Advantage (MA) plans in 2022 will offer non-medical supplemental benefits, such as meals, nutrition, transportation, and in-home support services, at a $0 premium. The most commonly offered benefit of the four analyzed is meals (68 percent), followed by transportation (39 percent), nutrition (30 percent), and in-home support services (11 percent). The percentage of plans offering these types of benefits will increase from 2021 to 2022, with the largest increases for nutrition and in-home support.
Moving Health Care Upstream: (October 2021) - For cross-sector partnerships to move the needle on population health outcomes, truly addressing root causes of health inequities, “which” integrative activities a network chooses to focus on is as important as “how” the integrative activities are put into action in the real world. As part of its work related to population health integrators and social determinants, Nemours Children’s Health has released new toolkits designed to support networks in strengthening strategic use of integrative activities- including tools for assessment, alignment, action planning, and implementation
Health Affairs: (October 2021) - Health Affairs interviewed ten Black women who support Black birthing people in February 2021 to identify strategies to address racism and inequities in maternal and infant mental health care. The researchers found five key pathways to address racism and inequities: educating and training practitioners; investing in the Black women mental health workforce; investing in Black women–led community-based organizations; valuing, honoring, and investing in community and traditional healing practices; and promoting integrated care and shared decision making.
Data and Innovation
Medical Economics: (10/28) - While digital technology has made it possible for clinicians to have an increased amount of data on their patients, the data has to meet some important standards for clinicians to make evidence-based decisions using the data to produce better health outcomes. This article discusses how leveraging advanced analytics enables clinicians to quickly sift through volumes of data–including SDOH–to get actionable information at the point of care, and proposes six ways analytics at the point of care can improve patient care.
Healthcare Finance News: (10/20) - On this episode of HIMSS TV, ProMedica's Sandy Lewallen shares why there needs to be a bidirectional flow of social determinants of health information about a patient between health care systems and community organizations.
EHR Intelligence: (10/19) - According to the Robert Wood Johnson Foundation’s National Commission to Transform Public Health Data Systems, all sectors must work together to achieve health equity through a robust public health data exchange infrastructure. The Commission recently released a set of recommendations that aim to consider how the public health data system can do a better job at preventing health inequities and boost interoperability in support of health equity. The recommendations emphasized placing health equity at the center of public health data exchange infrastructure, which requires collecting data across population groups by race, ethnicity, and geography and investing resources where they are most needed.
Health IT Analytics: (10/19) - A recent study examined how different SDOH impact risk prediction models to determine the likelihood that a patient is referred to a social worker and hospital admission following a primary care visit. According to the study, informatics and clinical researchers are increasingly shifting their focus to area-based SDOH to analyze patient-level clinical datasets. While SDOH are not always the most reliable data points to measure an individual’s characteristics, information regarding their living environment can provide significant insight into a patient’s health.