SDoH Newsletter - No. 10 - Summer 2022 by WilmingtonFRA

RISE News National mental health hotline—988—offers greater access to care, but may not have enough staff to manage demand

Actionable health care insights directly from consumers facing SDoH barriers Programs prioritize health equity: 3 new initiatives aim to address equity throughout the US Nº 10 - Summer 2022

THE LATEST NEWS Deloitte: Health care inequities could cost the country $1T by 2040

Regulatory roundup: HHS issues guidance on HIPAA and audio-only telehealth; OIG report recommends CMS improve race, ethnicity data to assess disparities; and more

Supreme Court overturns Roe v. Wade

Race is often used as medical shorthand for how bodies work, some doctors want to change that

5 things to know now that the Supreme Court has overturned Roe v. Wade

Patients seek mental health care from their doctor but find health plans standing in the way

Biden signs executive order to protect access to abortion, contraception

Study reveals persistent health disparities in opioid treatment access

Regulatory roundup: HHS: Providers must offer abortions in emergencies; Marketplace insurers denied nearly 1 in 5 in-network claims in 2020; and much more

HHS launches Office of Environmental Justice to address environmental inequities in health

Colorado to become first in the US to amend federal waiver, create public health option

Gen Z patients want their providers to ask about SDoH

Commonwealth Fund Commission: 4 recommendations to build a national public health system

Glaring racial disparities persist in early-onset colon cancer survival rates, study finds

HHS, USDA request nominations for 2025 Dietary Guidelines Advisory Committee

Study shows SDoH play key role in home care transition experience

KFF: Up to 14M could lose Medicaid coverage after end of COVID public health emergency, fed continuous enrollment requirement

Surgeon General Advisory lists 6 proposals to address health worker burnout and resignation

READ OUR ENTIRE COLLECTION OF INSIGHTS AND ARTICLES 2

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States have yet to spend hundreds of millions of federal dollars to tackle COVID health disparities

SDoH IN THE NEWS ACAP launches new center for SDoH innovation; White House joins private health sector to reduce climate impacts, protect public health; and more

Study suggests increased awareness of COVID-19 racial disparities backfiring in safety precautions; UnitedHealth invests additional $100M for affordable housing; and more

Older adults’ mental health issues, drug-related deaths worsened over last decade; ADA receives health equity grant to improve Black communities; and more

More than half of US adults struggle with loneliness; HHS invests $15M to address drug use in rural communities; and more

Regulatory update: CMS outlines action plan to advance health equity; CDC launches National Weather Service-like forecasting center for infectious diseases; and more

Virtual reality program aims to address SDoH; Health inequities could triple cost of health care by 2040; and more

US health care system fails to support women’s health, study finds

Study: Financial education improves health outcomes

Gun safety ‘wrapped in a mental health bill’: A look at health provisions in the new law

In-home health evaluations play a critical role in diabetes prevention and management for seniors

BCBSA calls for data standardization to further health equity

CMS issues the 2023 Medicare Advantage and Part D Final Rule: 10 things to know

Study identifies race and income as critical SDoH for children with autism

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Letter From the Chair

THE STATE OF THE SDoH ON A

DAY OF MAJOR IMPAC

Ellen Fink-Samnick, chair of RISE’s SDoH Community, reflects on the state of the industry in the wake of the Supreme Court’s decision to overturn Roe v. Wade.

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In preparing to write this quarter’s newsletter column for RISE’s SDoH community, I pondered the state of social determinants of health. I was excited to share a review of the latest industry news, studies, and reports on health equity, including: • The CDC report on lack of availability to COVID treatment in the areas of highest need • Increased data validating the impact of, redlining on health outcomes, and especially across chronic illness • Ten million dollars in HHS grant funding for rural health communities to manage the surging fentanyl and opioid overdoses • From PCORI, $63 million to reduce maternal health inequities and $50 million for research on management of multiple chronic conditions, which also heavily impact those dealing with SDoH • Advocacy of the Gravity Project in advancing further ICD-10-CM Z codes; the FY23 ICD-10-CM release in October will see codes for transportation insecurity, financial insecurity, material hardship, as well as treatment plan non-adherence, and financial hardship Yet, as I started to craft this column on Friday, a breaking news notification ran along the top of my computer screen. I saw it was about the SCOTUS decision in the Dobbs v. Jackson case and clicked to read more; Roe v. Wade had been overturned and my heart sank. There would be mass impact of this decision across systems and sectors. The media news blitz was immediate. My primary concern was for our most vulnerable and marginalized populations. They already suffer rampant access to care obstacles. Women of color are less likely to have early access to maternal health care, contraceptive care, and other reproductive health services, which puts them at a higher risk for poor maternal health outcomes. The Turnaway Study released earlier this year revealed grim realities for women denied an abortion: they are four times as likely to end up living in poverty, stay with abusive partners, suffer from poor physical and mental health, and have decreased aspirations.

Many of you may know that I’m a data fiend, so I’ll let the facts do the talking. Moving forward, we can expect: • Increased inaccessibility of reproductive services for women and families across states. • Less options for providers and women suffering from ectopic pregnancy, pregnancy loss, or other complications, particularly in states with the most restrictive abortion policies • Increased anxiety, fear, and hesitancy for individuals to seek or provide care in states where abortion is illegal, 16 states at the time of this writing and expected to rise • Thousands of unplanned births and the potential for increased maternal morbidity and mortality • Increased mental health challenges for persons dealing with unwanted pregnancies • Higher rates of suicidal ideation, gestures, and action for victims of rape, sexual assault, or interpersonal violence who carry a pregnancy to full-term • Forty-five percent of pregnancies are unplanned but for teenagers that rate increases to 75 percent • There will be a ripple effect to college-aged students; many will be forced to raise children on college campuses or give up hopes of earning a degree I am full of many emotions. Yet, at the same time, I find comfort in knowing that our community members will do what they do best, define strategies that mitigate the gaps in care. There will be legislative advocacy and appeals, grant funding, and community partnerships. Organizations, associations, and credentialing entities are publishing their opposing position statements. Safeguards are being put in place to protect all populations across the diversity, equity, inclusion, and cultural landscape, including the LGTBQIA community, persons with disabilities, immigrants, and all disenfranchised groups. New programs to leverage public health will evolve, as will other imperatives to build health and mental health equity. This is not our first fight, #SDoHWarrior, nor will it be our last; we shall get through this latest assault on public health together. • Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CCTP, CRP, DBH-C, SDoH Community Chair The RISE Association

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after a new diagnosis would have been extremely helpful. Another panelist said that getting a booklet after diagnosis from their health plan that detailed how to better deal with their condition, what is covered, and what other services are available seemed like a no-brainer on how to support condition management. Shannon O’Connell, senior manager, Engagys, shares the biggest takeaways after moderating the consumer focus panel, Direct Insights into Addressing Social Determinants of Health from Patients Themselves, at The RISE Summit on Social Determinants of Health in Nashville last March. Recently at the RISE Summit on Social Determinants of Health, I had the privilege of co-moderating a panel of consumers affected by social determinants of health (SDoH) barriers. We had a candid conversation with six panelists who shared their real and important opinions on their health experiences, access to care, and ways to improve health plan and medical care services. The reason we co-hosted this panel was to hear firsthand the challenges this population faces daily and then turn these powerful insights into action. When incorporating their feedback into programs and services, health care organizations can improve not only the health care they receive but also their overall quality of life. While each panelist faces unique challenges, we found common ground throughout. Here are the top insights from the panelists on how to influence positive change.

More Personalization When it comes to getting support on managing their unique health conditions, all the panelists wanted information that was personalized to their specific diagnosis and needs. A few mentioned that getting personalized health information right 6

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PANELIST QUOTE: “If I had someone who would give me more information on how to more deal with my specific situation, chronic kidney disease, watching my intake of potassium and phosphorus, these are things that I never knew. So yeah, if someone could give me information on my situation and single it out.” PANELIST QUOTE: “If the (health insurance) providers provided a booklet to be sent to us when we are diagnosed that would be your provider and your condition, say for example UnitedHealthcare and Diabetes – What You Can Expect and Your Benefits. I mean, that’s just simple. It’s a booklet that would go to you when you get diagnosed.”

More Communication Channels Each panelist liked their communications from different channels but agreed that they often got it from more than one channel source. One panelist said she got monthly phone calls from a nurse but didn’t answer because she didn’t recognize the number. She would listen to the voicemails later though. With that insight, a better way to reach and engage this population would be through multi-channel communications all pointing to more information that would either come through the mail, be accessed online through email or the portal, or through a call-back number. Another strategy that health organizations should employ here is capturing and using member channel

preference as some had strong feelings about how they wanted to receive the information. PANELIST QUOTE “I do get a lot of phone calls – a lot of voicemails because I don’t recognize the number so it goes to voicemail but they give a call-back number, call you back, and they want to know how you’re doing. I get those calls probably once a month.” PANELIST QUOTE “As long as you make sure it (the email) goes to my inbox, I will see it.” PANELIST QUOTE “I get some from email, but I go to the website. I have an account with my health plan, and I can look up all my claims and basically the booklet you get through the mail, all that information is there and I’ll look through that.”

More Social Media Presence The panelists that are active on social media revealed that they don’t see any information about health plans when visiting those sites and that it would be helpful way to get health plan information. Social media is seen as a valid channel to get information and enhancing your organization’s social media presence is a great way to remind current members about their benefits and advertise to potential members. PANELIST QUOTE: “I mean for me, I’m on social media. I’m on Facebook. I’m on Instagram and a lot of other things and there’s commercials on some of them. I don’t think I’ve ever seen an insurance commercial on any of them. So for me, I guess that would be beneficial if you could see it on that if you are on social media a lot.” This article is an excerpt from a blog post originally published by Engagys, LLC. To view the full article, click here. •

PROGRAMS PRIORITIZE HEALTH EQUITY: 3 NEW INITIATIVES AIM TO ADDRESS EQUITY THROUGHOUT THE US A spotlight on recent organizational efforts and partnerships that promote health equity in different ways.

AMA partners with organizations to incorporate equity lens into patient care The American Medical Association (AMA) announced it is collaborating with Brigham and Women’s Hospital and the Joint Commission to promote health equity and improve health outcomes in vulnerable populations. Through the partnership, the organizations have formed the Advancing Equity through Quality and Safety Peer Network, a one-year mentorship and networking pilot program

that aims to integrate equity in all aspects of health care delivery and patient care. The network consists of eight participating health systems, including: • Atlantic Medical Group/Atlantic Health • Children’s Hospital of Philadelphia • Dana-Farber Cancer Institute • University of Iowa Hospitals & Clinics • Ochsner Health • The University of Texas MD Anderson Cancer Center • Vanderbilt University Medical Center • University of Wisconsin Hospitals & Clinics “For the past two years, the COVID19 pandemic has further exposed

systemic inequities in the quality and safety of the patient care experience—including gaps in interpretation services, telemedicine access, and crisis standards of care,” said AMA President Gerald E. Harmon, M.D., in a statement. “Through collaborations like the Peer Network, the AMA continues its work to remove the social and structural factors that interfere with patient-centered care—providing health systems with guidance to inform equitable solutions, dismantle inequities, and improve health outcomes for our patients from historically marginalized communities.” As part of the program, the health systems will learn strategies to systemically identify and address inequities and follow a framework designed by

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the Brigham and Women’s Hospital and the Institute for Healthcare Improvement to implement a patient-centered approach to deliver equitable care.

BCBS of Massachusetts launches program to support entrepreneurs of color Blue Cross Blue Shield (BCBS) of Massachusetts announced the launch of the Health Equity Business Accelerator, a program that will provide financial, strategic, and mentorship support to start-up founders of color to help create equitable health care services and solutions. The program includes a $150,000 investment and nine months of tailored programming with program partners, including The Capital Network and Healthbox. “This is not a philanthropic act - it’s a good investment and business decision,” said Andrew Dreyfus, president and CEO at Blue Cross, in a statement. “By investing in these diverse start-ups, we’re able to help support the growth of businesses that are centering equity

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in their work and making advances in technology and services that will lead to improved health outcomes.” The program will begin with an initial group of five companies nominated for participation with plans to expand the program after the ninemonth pilot.

Organizations form coalition to address health disparities through digital health The Digital Health for Equitable Health (DHEH) Alliance, a new coalition made up of organization across the health care system, academia, and patient and physician advocacy, aims to address health disparities for low-income, minority, and underserved populations throughout the country through digital health. The DHEH Alliance aims to advocate for policies and programs striving to improve equitable access to quality health care through initiatives such as digital health, telemedicine, wearables, artificial intelligence, and machine learning. Organizations within the coalition share focus areas including

improving access to data, access to digital solutions, digital health coverage, access to broadband, diversity in clinical trials of digital health solutions, and digital health literacy. “DHEH will be a change catalyst that transforms health for Americans in every corner of our nation, and we can do that by collaborating across different sectors and systems, and by leveraging resources to amplify impact and mobilize resources for underserved communities,” Tanisha Hill, president of DHEH and U.S. senior medical director, respiratory and digital health medical lead at Teva Pharmaceuticals, said in a statement. “Equity isn’t just a buzzword, it’s a critical movement that will save lives and ensure that, regardless of income, ethnicity or gender, all Americans can access digital technologies that can remove barriers to healthcare management and critical health services. Only by working together, can we make meaningful change in the lives of millions of people, and I encourage others to explore our mission and join us.” •

NATIONAL MENTAL HEALTH HOTLINE—988—OFFERS GREATER ACCESS TO CARE, BUT MAY NOT HAVE ENOUGH STAFF TO MANAGE DEMAND The need for services is great. U.S. Centers for Disease Control and Prevention reports that the United States had one death by suicide every 11 minutes in 2020. Suicide was the second leading cause of death for ages 10-14 and 25-34. And a recent Kaiser Family Foundation brief notes that suicide deaths are increasing fastest among people of color, males, younger individuals, and individuals living in rural areas.

A new report by the Wall Street Journal raises questions on whether the launch of a new national mental health crisis/suicide prevention number, 988, will be able to fulfill its mission to make it easier for more people to connect with counselors. The newspaper’s analysis found that 1.5 million calls out of 9.2 million calls to the National Suicide Prevention Lifeline between 2016 and 2021 ended before the caller reached a counselor. Callers were either disconnected or abandoned the calls. The report comes days before the July 16 switch from the crisis line’s 10-digit number to the three-digit, 988. On that date all telecommunication carriers must provide access to 988, which will direct calls to free crisis counseling at one of approximately 200 crisis centers across the country. The three digits will be easier to remember and will likely lead to an increase in calls but there are concerns that call centers across the country won’t be able to handle the demand.

A June 2022 report by RAND surveyed 180 officials on their preparedness for the launch of 988. Fifty-one percent said they weren’t involved in the development of a strategic plan related to the launch and only 16 percent reported they had developed a budget to support 988 operations. And call centers are still looking for crisis counselors and staff for mobile response units, which dispatch mental health professionals and paramedics when people are in crisis, according to NPR. Although the National Suicide Hotline Designation Act of 2020 mandated the creation of 988, it didn’t require states to expand crisis call centers or mobile response networks, noted Jerome Adams, M.D., former U.S. surgeon general, in an opinion piece for USA Today. Indeed, a recent Kaiser Family Foundation (KFF) issue brief notes that though the federal government mandates 988, states are responsible for most of the funding and implementation.

states and localities have an adequate infrastructure to treat people with mental illness. As a result, even with 988, those in crisis might find it hard to get effective help, especially in rural communities,” Dr. Adams wrote. To help with the transition to 988 and beef up capacity for crisis call centers, the Department of Health and Human Services (HHS) provided $282 million in 2021 and this spring awarded nearly $105 million in grants to states and territories. The funds were to be used to improve response rates, increase capacity to meet future demand, and ensure calls initiated in their states or territories are first routed to local, regional, or state crisis call centers. But because state officials are unsure they have enough funds and staff to handle all the expected calls to 988 as well as longtime funding needs, Politico reports they are planning on a quiet launch for the new hotline number on Saturday, rather than a marketing campaign with much fanfare. •

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UPCOMING EVENTS SDoH User Group (Meeting 4)

Thursday, November 17, 2022 1:00PM EST

The RISE Population Health Summit

VISIT THE SITE

November 15-16, 2022 A live-streaming virtual event

The RISE Women in Health Care Leadership Summit December 14-15, 2022 InterContinental San Diego | San Diego

The 8th Annual Medicaid Managed Care Leadership Summit April 2023 Location Pending

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QUESTIONS? REACH OUT TO OUR TEAM

Ilene MacDonald Editorial Director

imacdonald@risehealth.org

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Tricia Rosetti Content Marketer trosetti@risehealth.org

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