SDoH Newsletter - No. 9 - Spring 2022

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RISE News Mariam Merced receives inaugural RISE Health Care Hero Award 5 takeaways from The RISE Summit on Social Determinants of Health 10 health care podcasts you should listen to in 2022

Nº9 - Spring 2022


THE LATEST NEWS SDoH in the news: HRSA updates ACA health care guidelines to improve care for women and children; Survey finds gap in between health system’s DEI goals and actionable progress; and more

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SDoH in the news: Report underscores impact of climate change on health; 1 in 10 children struggle with food insecurity; and more

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Diverse patient engagement approaches reduce barriers to patient retention

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Study finds racial prejudice causes poorer health outcomes

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HHS announces funding initiatives to promote mental health among health care workers, improve behavioral health in rural communities

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Pandemic medical innovations leave behind people with disabilities

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Biden administration’s rapid-test rollout doesn’t easily reach those who need it most

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HHS study finds concerning increase in children diagnosed with mental health conditions

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The Commonwealth Fund outlines framework to assess racial equity in health policy

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Physicians don’t have time to address patients’ SDoH, study finds

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The 2023 Medicare Advantage and Part D Advance Notice is out: What you need to know about the proposed changes

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Beyond the Z codes: Promoting health equity and population health through advancing the use of SDoH data

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Centauri Health Solutions, Inc. SDoH in the news: National survey highlights disparities in telehealth use; Older adults in US more likely to report mental health condition than other countries; and more

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Addressing social determinants begins with data

Covid precautions are part of Hispanic community’s efforts to tend to community good

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Improve population health outcomes for Medicare beneficiaries

Signify Health

Real Time Medical Systems Health care firms were pushed to confront racism, now some are investing in Black startups

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READ OUR ENTIRE COLLECTION OF INSIGHTS AND ARTICLES 2

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riahC e t morF eL We are on the heels of yet another powerful RISE Summit on Social Determinants of Health. Those who attended experienced sheer electricity as some 500 SDoH warriors and 40 sponsors and exhibitors took part in three days of dedicated knowledge-sharing and networking. The energy of RISE’s rapidly growing SDoH Community was front and center as legislation, funding, new financing models, successful programming, and strategies were discussed. If you couldn’t join us, we’ve got you covered with our biggest takeaways on page 4. Of particular note this year was the rapid expansion of social risk programs and analytics to support accessing appropriate resources. With National Health Expenditures at over $4.1 trillion, health care organizations and systems are working harder than ever to reign in their rising costs. Successful patient clinical outcomes should yield fiscal sustainability for organizations. Attaining this holy grail relies on sound assessment of a population’s social needs and linkage to sufficient resources, as well as appropriate reimbursement. Yet, two other priorities loom large in the SDoH space: technology platforms that provide end to end care solutions and aligned programs that assess and measure the social intelligence of their efforts.

THE AGE OF (SOCIAL RISK) ANALYTICS Both of these priorities were center stage at the summit, courtesy of two major industry announcements earlier in March. First, North Carolina’s Healthy Opportunities’ long-awaited initiative was unveiled. The program is the nation’s first comprehensive program to test evidence-based, non-medical interventions designed to improve the health of Medicaid beneficiaries while reducing costs. A new social care payments solution from Unite Us fuels this initiative, which provides up to $650 million in Medicaid funding for pilot services related to housing, food, transportation, and other social needs. The Unite Us solution is the only end-to-end solution for social care, streamlining implementation and management of paid social care programs across health care funders, encompassing health plans and managed-care organizations. Of equal note, Socially Determined announced a new social risk score

enabling organizations to better understand the impact that social connections can have on health outcomes and business performance. Their new Social Connectedness metric joins the company’s other existing social risk scores, including Digital Landscape, Economic Climate, Food Landscape, Health Literacy, Housing Environment, and Transportation Network. The newest metric analyzes those influences of loneliness, social network quality, and social capital and assesses how they intersect to impact communities and the people who live there. Add these programs to other platforms that have emerged in recent years, and one theme is clear: the industry has transitioned from the priority of seeking appropriate SDoH resources to enhance patient outcomes to the use of social intelligence metrics that assess, prioritize, link, and reimburse for them. It’s inspiring to consider how far innovation will go to mitigate the SDoH overall. ◆ Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CCTP, CRP, DBH-C, Social Determinants of Health Community Chair The RISE Association

CONGRATULATIONS to our Community Chair, Ellen Fink-Samnick, who was awarded the 2022 Social Worker of the Year award by the National Association of Social Workers−Virginia and Metro DC Chapters.

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5 TAKEAWAYS FROM THE RISE SUMMIT ON SOCIAL DETERMINANTS OF HEALTH

This year’s summit drew a record-breaking number of more than 500 attendees live in Nashville to learn and discuss actionable solutions to social determinants of health (SDoH) challenges to achieve better outcomes for vulnerable populations. With three preconference workshops, three content tracks, an impressive lineup of more than 80 speakers, and 28 thought-provoking sessions, this year’s event provided more content and open discussion than ever before. Here’s a recap of our biggest takeaways from the 2022 summit.

A value-based health care system is critical to address SDoH The push to value-based care continues to be a focal point in the discussion around SDoH. Seema Verma, who served as administrator of the Centers for Medicare & Medicaid Services (CMS) during the 4

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Trump administration, emphasized the importance of going “all-in” on value-based care payment models to make real strides in the social determinants space.

open data sharing to understand the patient’s complete medical and social history, providers can hardly care for the whole person. You can’t care for what you don’t know,” she said.

“Value-based care is the opposite of fee-for-service and shifts financial incentives away from volume and toward reducing costs, preventing disease, and improving quality and outcomes,” said Verma during her keynote presentation. “When providers are paid not primarily for administering tests and treatment, but because they maintain or restore beneficiaries’ health, the entire incentive structure of our health care system suddenly shifts toward addressing SDoH.”

Verma underscored the need for standardized SDoH data and interoperability between providers so they can exchange data to inform patient care, connect patients with necessary community resources, prevent duplicative workflows, and provide higher quality care.

But the shift of financial incentives is only half of the equation to moving to a value-based care system that addresses SDoH, said Verma, noting the weight technology and data carry to move payment mechanisms forward in health care. “Without effective,

SDoH funding requires creativity and collaboration As always, funding of SDoH initiatives and programs was a hot-button topic at this year’s conference. But as progress continues to be made in addressing SDoH, organizations are learning new and innovative approaches to acquire funding to support their efforts.


During a panel discussion, stakeholders from different corners of the SDoH world shared examples of these creative financing mechanisms and how other organizations can establish similar models. Each of the funding models relied on private-public partnerships and were structured with an outcomes-based framework so that partners received payments if they achieved results. The funding model encompasses a strategic use of dollars and not only improves health care but saves money, explained the panel. “The power of the private-public partnership is about bringing together a partnership aligned around outcomes. If we can bring in different and new stakeholders into the conversation, measure outcomes, and hold ourselves accountable, we are finding that we’re getting to better outcomes,” said Andi Phillips, managing partner, Maycomb Capital, who served as a panelist during the session.

The industry must address racism to truly impact SDoH Racism as a social determinant was an important conversation throughout the two-day summit. With the pandemic highlighting health inequities among communities of color and exacerbating longstanding disparities, as well as racial injustices across the country, systemic racism has become a larger conversation, particularly among SDoH stakeholders. Several sessions and speakers at this year’s summit stressed the need to address racism to truly move the needle in SDoH. During a panel discussion spotlighting how Nashville has leveraged cross-sector collaboration among providers, institutions, and civic leadership to provide equitable care amid the pandemic, racism and the barriers to care it poses was a key conversation point. While discussing the role racism plays in SDoH, panelist James Hildreth, Ph.D, M.D., president & CEO, Meharry Medical College, said people of color face disadvantages when it comes to six structural social

determinants, including education, health care, housing, social context, academic stability, and technology. “If you probe enough, there is one thing that bypasses all of those− racism has played a part in creating barriers to all of those,” said Hildreth, who is also the founder, Consortium of Black Medical Schools, and serves as a member of the Biden-Harris Administration COVID-19 Health Equity Task Force. “Until you fix that problem, none of those things are going to be solved.” DeAnna Minus-Vincent, MPA, executive vice president, chief social justice & accountability officer, RWJBarnabas Health, echoed a similar message during a track session on the organization’s mission to end racism as a social determinant. While sharing the organization’s commitment and declaration to be an anti-racist organization, Minus-Vincent shared the step-by-step process RWJBarnabas Health has had to take to address racism within the organization and how it’s striving to evolve. “It’s one thing to be not racist but being anti-racist is being proactive to change policies, processes, and procedures to change systemic racism,” she said.

Diversity, equity, and inclusion (DEI) is the foundation to organizational success The second day of the conference featured a keynote presentation with Certified DEI Trainer Kevin Coleman, empowerment coach and trainer, KMC EMPOWERMENT LLC, who shared what it takes to invite DEI culture within an organization, the importance in recognizing your own unconscious biases and microaggressions, and the value DEI holds within an organization. Implementing a culture of DEI benefits an organization in multiple ways, according to Coleman, including reducing cost and capturing unrealized opportunities. “When you’re missing someone at the table, you’re missing an awareness, unrealized opportunities,” he said.

When employees feel a sense of belonging within an organization, they are engaged and committed, fostering an all-in mentality in the work they do. “When you prioritize things like DEI, you have people want to do more for you, they want to be a part of what you’re doing, they want to put in the extra effort,” Coleman said.

Cross-sector partnerships are proving to be the successful path forward Year after year, the RISE Summit on Social Determinants of Health brings together cross-sectional thought leaders for idea exchange and networking. And as efforts around SDoH have progressed over the years, industry changemakers have found cross-sector collaboration to be the most effective strategy to achieve better outcomes. During a session demonstrating a successful cross-sector partnership, a group of diverse stakeholders shared how they collaborated to co-design the social care delivery system, Partnership to Align Social Care, a National Learning and Action Network. The collaboration includes senior leaders from community-based organizations (CBO), health plans, health systems, and national associations partnering to support health and social care delivery through a sustainable, community-centered delivery system that enables value-based care. “COVID has shone light on the need for this kind of coordination,” said Kelly Cronin, deputy administrator, center for innovation and partnership, Administration for Community Living. “It really brought to light that we need an organized system. We value this partnership across health care leaders and community leaders; we all need to learn from each other to figure this out.” Since forming the collaborative social care delivery system amid the pandemic, the partnership has enabled a network of more than 25 CBOs to further improve health outcomes in communities throughout the country. ◆ CLICK TO SEE OTHER ARTICLES

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Evetn Arelcit Suyram

MARIAM MERCED RECEIVES INAUGURAL RISE HEALTH CARE HERO AWARD

Ellen Fink-Samnick, pictured right, presents the RISE Health Care Hero Award to Mariam Merced. 6

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Nominations are Now Open for the 2023 Award! Submit a nomination today.


RISE is pleased to announce that Mariam Merced, MA, director, RWJUH community health promotions, New Brunswick, Robert Wood Johnson Barnabas Health, was awarded the inaugural RISE Health Care Hero Award at The RISE Summit on Social Determinants of Health.

• Coordinated COVID-19 response p ro g ra m s , i n i t i a t i ve s , a n d communications to support residents experiencing poor health, social, and economic outcomes as a result of the pandemic and resulting disparities Fellow award finalists included Anthony Davis, community health worker, Penn Center for Community Health Workers, and Dr. Frederick Echols, health commissioner, St. Louis City Department of Health.

The RISE Health Care Hero Award is a new accolade presented at The RISE Summit on “Mariam Merced Social Determinants “She is truly a health care hero has spent the past of Health that decades acknowledges an to so many, having a lasting t h r e e improving health individual’s effort impact on every resident and outcomes and to make a signiffar beyond the region,” quality of life for icant impact on individuals and the lives of undercommunities throughout Middlesex served populations through health County. Her passion and dedication care and/or social services intervento serve others knows no bounds–even tions, and through superior example using a bullhorn to get important mesof the RISE mission to promote health sages out to the community,” wrote equity among all patients. Lauren Scrivo-Harris, government Merced was chosen from a pool of 29 affairs and public relations spenominees for the award for her work to cialist, RWJBarnabas Health, in the address social determinants of health nomination. “Throughout her tenure, (SDoH), the non-medical factors that she has been a staunch advocate for impact an individual’s health, throughsupporting patients and neighboring out the New Brunswick community. communities through programs, such Among her many accomplishments: as holiday celebrations for low-income children, violence prevention and • Oversaw the development of a intervention, drug and alcohol cessaregional health consortium tion, back-to-school donations, youth • Spearheaded a medical summer employment programs, and interpreters’ project to provide community health screenings.” in-person interpretation services Merced also actively partners with as an alternative to the hospital’s houses of worship, health institutions, telephone language line and community-based organizations • Developed a domestic violence throughout the community to ensure training program to educate more culturally appropriate health initiathan 600 health care workers, tives for diverse populations. across three states, about the public health impact of domestic violence • Led efforts to expand access to safe and affordable housing and raise awareness of housing as a key SDoH

“She is truly a health care hero to so many, having a lasting impact on every resident and far beyond the region,” wrote Scrivo-Harris in the nomination.

Merced credits her passion for social impact work and her longstanding career in community health to her first job in medical school as an outreach worker, what she views as her “bootcamp” to SDoH. “I learned early on the barriers to care, the effects of housing on health, the lack of job with insurance, issues with health literacy, violence in communities,” Merced told RISE. “But the most important thing I learned is our communities have assets—they have hopes, they want to do better, they want to be healthy. There are so many possibilities for them to do better for themselves and their families.” Through all she does, Merced strives to serve as a trusted face within the community. “People trust people, they don’t trust buildings,” she said. “I will always look at this community with hope. They want to do better, and we have to go out there and fulfill our promises.” ◆

“...the most important thing I learned is our communities have assets—they have hopes, they want to do better, they want to be healthy. There are so many possibilities for them to do better for themselves and their families.”

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The Dose by the Commonwealth Fund Hosted by the Commonwealth Fund’s Shanoor Seervai, the bi-weekly podcast, The Dose, focuses on current issues in health care across the country and abroad. Each episode features a conversation with a health policy expert about a specific health care issue and the answer to the question: What could the U.S. do differently? Recent episodes concentrate on child vaccination rates, equity in reproductive health, the state of the pandemic and vaccination rates, and health care among transgender people who lack housing.

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HEALTH CARE PODCASTS YOU SHOULD LISTEN TO IN 2022 Whether you want to learn more about health policy, health equity, COVID, or the latest news, we’ve gathered our picks for health care podcasts with a focus on population health and social determinants of health to add to your listening library. And a shameless plug – of course RISE Radio is on the list!

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Healthcare Executive Podcast

Produced by the American College of Healthcare Executives, the podcast offers meaningful discussions with health care leaders. Industry experts share insights on topics ranging from improving physician engagement, health equity, and addressing institutional racism in health care organizations.

RISE Radio

We’d be remiss not to include our own podcast, RISE Radio, which features interviews with industry leaders about policies, regulations, and challenges faced by health care professionals in our three communities: Quality & Revenue, Medicare Member Acquisition & Experience, and Social Determinants of Health. Since the launch of our first podcast in February


2021, we’ve featured interviews on population health, Star ratings, telemedicine, and emerging drug threats.

What's Health Got to Do with It?

A weekly 53-minute podcast from WJCT News that examines where health care intersects with life and helps guide listeners through an increasingly convoluted medical bureaucracy. It is hosted by Joe Sirven, M.D., a practicing physician journalist who is an expert in all facets of health care. The program covers wide-ranging topics such as medical trends, disabilities, the racial makeup of U.S. doctors, pancreatic cancer awareness, and Alzheimer’s treatment and prevention. BROWN SCHOOL OF PUBLIC HEALTH PODCASTS The university produces two insightful podcasts we recommend giving a listen: Humans in Public Health and COVID: What comes next?

Humans in Public Health

Brought to you by Brown University’s School of Public Health, the special podcast series for National Public Health Week explores the many facets of public health. In the five-episode series, podcast host and Brown University Adjunct Lecturer Megan Hall interviews university public health experts to shed light on how public health impacts all aspects of our lives. Episodes feature thought leaders experienced in community outreach and education, toxic plastics, COVID hotels and homelessness, anxiety, and race and genetics.

COVID: What comes next?

Hosted by G. Wayne Miller, health care reporter with Providence Journal and the USA TODAY network, the weekly podcast features insights from Ashish Jha, M.D., a pandemic expert and dean of Brown University’s School of Public Health, on events across the world each week and what lies ahead. Recent episodes focus on the Omicron variant, vaccine effectiveness, booster shots, and vaccine approvals for children. HEALTH AFFAIRS PODCASTS The peer-reviewed journal of health policy thought and research produces three podcasts : A Health Podyssey, Health Affairs This Week, and Narrative Matters.

news in 15 minutes or less. Recent episodes featured conversations on the WHO’s Climate and Health Report, health spending, the Affordable Care Act and health policy at the Supreme Court, and global health inequity. To catch up on what’s happened this year beyond COVID, listen to the podcast’s year in policy review episode.

Narrative Matters

For those who want to go beyond the printed page of the journal, the podcast offers a chance to listen to essays, often read by their authors. Recent episodes feature a health care leader who shares her story of living with major depression and calls for better treatments and a physician who is struggling with the debilitating symptoms of long COVID.

A Health Podyssey Next Up The weekly podcast is for health policy fanatics who want to know the stories behind the research and policy implications. During each episode, Health Affairs Editor-in-Chief Alan Weil talks with leading researchers and influencers who shape the big ideas in health policy and the health care industry. Recent episodes have focused on health care payment reform, the controversial two-midnight rule, and state level changes in the nursing home and home care workforce.

Health Affairs This Week

The twice monthly podcast for health care leaders is produced by CareContent Inc., digital marketing agency for health care organizations, and hosted by its CEO Kadesha Thomas Smith. Recent episodes have covered the impending nursing shortage, navigating leadership changes in your organization, how to become a patient-centered health system, and prioritizing diversity, equity, and inclusion in 2022. ◆`

Each week the journal’s editors discuss the most pressing health policy CLICK TO SEE OTHER ARTICLES

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UPCOMING EVENTS The 7th Annual Medicaid Managed Care Leadership Summit April 26-27, 2022 A Live-Streaming Virtual Event

Part 2: The Next Step: Take your SDoH Data and do Something With it! Tuesday, May 17th | 1:30PM EST A RISE Association Webinar in Partnership with Pulse8

VISIT THE EVENT WEBSITE

VISIT THE EVENT WEBSITE

SDoH User Group (Meeting 2)

REGISTER HERE

Thursday, May 19th | 1:00PM EST

The Special Needs Plan Leadership Summit

VISIT THE EVENT WEBSITE

June 22-24, 2022 Westin Times Square, New York City

The RISE Value-Based Contracting Summit

VISIT THE EVENT WEBSITE

June 28-29, 2022 Caesars Palace, Las Vegas

QUESTIONS? REACH OUT TO OUR TEAM

Ilene MacDonald Editorial Director

imacdonald@risehealth.org

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Tricia Rosetti Content Marketer trosetti@risehealth.org

Tracy Anderson Marketing Coordinator tanderson@risehealth.org


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