Addressing Social Determinants of Health: National Institute for Health Care Management webinar
Social determinants of health (SDOH) are “the conditions in which people are born, grow, live, work, and age,” according to the WHO.[1] Examples of key issue areas include gender equity, early childhood education, social support, housing, transportation, and food security. Addressing social determinants of health is a growing trend in healthcare today, driven by the fact that environmental, social, and economic factors influence 50% of health outcomes.[2] Social determinants of health focus on health beyond medical care and seek to address the unequal distributions of money, power, and resources that cause avoidable differences in health outcomes. In a consumer health survey of over 2,000 individuals, respondents who self-reported poor physical or mental health were more likely to report multiple unmet social needs.[3] In addition, respondents reporting unmet social needs were more than two times more likely to report multiple ER visits in a year when compared to those without unmet social needs.[4] Focusing on social determinants of health, rather than behavioral or clinical causes of health, can improve health outcomes and reduce costs in the long-run.
The National Institute for Health Care Management (NIHCM), a non-profit organization dedicated to transforming healthcare with practical solutions, held a webinar last week on the Social Determinants of Health, which I was lucky to attend. The webinar focused specifically on technology and workforce approaches to addressing SDOH. The NIHCM Foundation has a network of partners in both federal and state governments, as well as in public health academia and the private sector, making them the perfect advocate for collaboration across sectors.[5] The goals of the webinar were to bring together public health stakeholders and to initiate partnerships between healthcare providers and social workers to address the social determinants of health.[6] Karen DeSalvo, Chief Health Officer at Google and Co-Convener of the National Alliance to Impact SDOH, spoke during the webinar about necessary frameworks to overcome the complexities of social determinants of health. Organizations should first define social risks and attempt to increase awareness of the impact of social determinants of health, then focus on reducing social risks at both the individual and community levels. Eventually, promotion of policies that change funding to address discrepancies in health and social resources will re-align sectors and close gaps in care. The next speaker in the webinar was Rivka Friedman, Director of Prevention and Population Health Group at the Center for Medicare and Medicaid Innovation (CMMI). She explained two CMMI models that address SDOH, the first, called the Accountable Health Communities (AHC) model. Launched in 2014, this model screened beneficiaries for health-related social needs and funded bridge organizations (like the YMCA and local health clinics) to connect with social service providers. The second model from the CMMI, called the Integrated Care for Kids (InCK) model, just launched in January 2020. Encouraging more collaboration than the AHC model, InCK funds communities to partner with state Medicaid agencies and establish care teams for at-risk children and pregnant women to reduce avoidable inpatient stays and improve health outcomes. Next in the webinar, Alan Gilbert, Vice President of Anthem Insurance, spoke about Anthem’s new business initiatives that address SDOH and improve care. The four key drivers of health interventions, and the four main areas addressed by Anthem’s initiatives, are enhanced care delivery, health food, employment/education/housing, and transportation and access to care. Kelli Tice Wells, Senior Medical Director of Medical Affairs at Florida Blue Insurance also spoke during the webinar and explained Florida Blue’s community health approach to addressing SDOH. Using local solutions, like utilizing local social workers, can help connect patients to health-related social care services and targets the environmental, social, and economic factors that affect health outcomes.
One of the main goals of the webinar was for stakeholders to collaborate on solutions to address the social determinants of health. Solutions require collaboration across sectors and industries, and so far, the health sector has done this by providing Medicare reimbursements for social services and addressing social needs in primary care visits.[7] Solutions will require more than just adjusted payment models, and will need broader policy support for funding health-related social services. During the webinar, Karen DeSalvo maintained that innovative financing solutions are necessary to address SDOH and proposed congressional action to increase the flexibility of Medicare programs, using transportation as an example to overcome physical barriers to care. Financing plans should avoid the medicalization of SDOH as DeSalvo described, and therefore will need to address the “wrong pocket problem” to make sure lower costs are shared among social services and community-based organizations. DeSalvo further explained that financing SDOH interventions will require a better understanding of pooling funds from public and private sectors, using as an example the Rhode Island Medicaid partnership with public transportation options. Alan Gilbert also offered examples of successful interventions addressing SDOH, and championed Anthem’s Blue Triangle case study in Indiana. This housing program in Indianapolis, made up of 53 studio apartments with on-site support staff, computers, and laundry facilities, started with the intention of addressing the homeless population of over 30,000 people. Collaboration between Anthem, community mental health centers, and the city of Indianapolis made the housing project possible, and the program has proven to substantially decrease utilization of crisis services.[8] Another solution proposed during the webinar from Alan Gilbert focused on addressing food insecurity for individuals with increased A1C and increased BMI. The CareMore health model incorporates the Helping Our Patients Eat (HOPE) food pantry into primary clinics, and provides fresh vegetables and fruits for Texas Medicaid patients. In collaboration with local food banks and Texas CareMore clinics, the program is a great example of successful partnerships between healthcare and social providers. Looking ahead, collaboration will be the key to driving change by linking health care and social needs.
[1] https://www.who.int/social_determinants/sdh_definition/en/
[2] https://www.nihcm.org/categories/sdoh-2019-infographic
[3] https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/insights-from-the-mckinsey-2019-consumer-social-determinants-of-health-survey
[4] Id.
[5] https://www.nihcm.org/about
[6] https://www.nihcm.org/categories/event/social-determinants-of-health-technology-and-workforce-approaches
[7] https://www.nihcm.org/categories/sdoh-2019-infographic
[8] https://www.csh.org/2019/04/anthem-and-indys-blue-triangle-housing-program/
Policy Interns 