Defying the Odds
Read how John QuiĂąones overcame poverty to become an Emmy Award winning journalist
nÂş2 - Summer 2020
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Staggering rate of loneliness identified in Cigna study
CDC study examines demographics behind coronavirus hospitalizations
Social determinants in the news: Patients postpone care amid pandemic; School closures leave children neglected and hungry; and more
Medicare eligibility expansions could improve existing racial and ethnic health disparities
Drastic health disparities intensify in communities of color amid COVID-19
A simple phone call goes a long way when it comes to loneliness amid coronavirus
7 tips to tackle stress and create resiliency amid COVID-19
New population health website enables researchers to examine SDoH in California as it relates to COVID-19
New CDC data emphasizes role homelessness plays in COVID-19 spread
Social determinants of health intensify alongside coronavirus
See our entire collection of Insights & Articles
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Social Determinants of Health Newsletter
CHANGES IN A POSITITVE DIRECTION In the few months since our inaugural issue of the Social Determinants of Health Community Quarterly Newsletter, COVID-19 has upended our world far beyond what most of us could ever imagine and has exacerbated the social factors that influence health as individuals across the United States struggle with access to health care and testing, food insecurity, and isolation. The outbreak has amplified the structural inequalities that have long been part of our health care system and revealed the serious negative impact of chronic underinvestment in behavioral and social services. Indeed, the impact of COVID-19 was clear during RISE’s virtual National Summit on Social Determinants of Health in June when eight SDoH clients from Nashville joined a panel discussion about their access to health care and perception of the health care system. They shared struggles with their ability to afford medical care, food, and medications during the COVID-19 pandemic. And though the expansion of telehealth services has proved to be a lifesaver for many, one client with post-traumatic stress disorder has been unable to meet with his therapist since the onset of the virus. He tried online therapy services, but it didn’t provide him with the same level of support. “There are some things you can talk to someone about face-to-face more than over Zoom,” he said. In this issue, you’ll read more about SDoH client perceptions, the need for cross-sector collaboration, as well as the recent findings from the RISE benchmarking survey on SDoH conducted in partnership with Alexandra Schweitzer, senior fellow at the Mossavar-Rahmani Center for Business and Government at Harvard Kennedy School. The survey addressed how health plans and communitybased organizations define success for programs that address SDoH and measure their outcomes and impact. The benchmarking survey was launched in January, prior to the COVID-19 outbreak, but during the summit, panelists said they believe the impact of the virus will inspire more investments in programs to address social barriers to health. We are already seeing changes in a positive direction. Shortly before this newsletter’s publication, the Centers for Medicare & Medicaid Services (CMS) put out a call to action to address SDoH, manage disparities in care, and improve outcomes. CMS Administrator Seema Verma said the disparities in care as seen by COVID-19 data underscores the urgent need for a value-based system designed to address SDoH. She called for incentives for providers to focus on the health of the whole person rather than simply the delivery of care. “We have to hold providers accountable for the outcomes they achieve, and poor health outcomes for minorities or those of a lower socioeconomic status is not acceptable. Until we move to a system that incentivizes value over volume and starts paying doctors for better health outcomes, we’ll never be able to adequately address the social determinants of health,” she said.
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INTO THE RESULTS OF RISE’S BENCHMARKING SURVEY ON SDOH
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Social Determinants of Health Newsletter
The benchmarking survey focused on how health plans and communitybased organizations define success for programs that address social determinants of health (SDoH) and measure their outcomes and impact. The research project was conducted in partnership with Alexandra Schweitzer, senior fellow at the Mossavar-Rahmani Center for Business and Government at Harvard Kennedy School, and launched in January, prior to COVID-19. Schweitzer revealed the survey results during a session at this week’s RISE National Summit on Social Determinants of Health and moderated a panel discussion about the findings. Survey respondents: Sixty members of the RISE community responded to the survey. Organizations represented payers, providers (hospitals, health systems, community health centesr), accountable care organizations (ACOs), community-
based organizations (CBOs), and government entities. Nearly 75 percent of respondents were from non-profit organizations. Payers included those who offer commercial, dual-eligible, Medicare, and Medicaid coverage. Most common goals for SDoH program • Meet a health care related social need (78 percent) • Clinical improvement (50 percent) • Reduce unnecessary emergency department or inpatient utilization (42 percent) • Reduce medical costs (39 percent) • To meet the organization’s mission (22 percent) • Exploratory pilot (19 percent) • Return on investment or ROI (17 percent) • Member satisfaction (11 percent)
Panel insight: Although Schweitzer expected mission and ROI to be a more prevalent goal, Jennifer Funaro, a national SDoH strategist, Centene Corporation, said that most common goals and less prevalent goals are not necessarily mutually exclusive. Most organizations have multiple reasons to support initiatives, including positive health outcomes that may be directly inline with some of the other goals outlined. She also cautioned that respondents may have not thought of the terms in the same way as organizations define them in different ways. Mohini Mishra, managing director of housing & NORCs, Selfhelp Community Services, Inc., agreed. She explained that mission is ingrained in everything CBOs do so she can understand why CBO respondents may not have listed it as a top priority.
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“It’s given and understood if you are working for a mission-driven organization,” Mishra said. “ROI alludes to the fact that CBOs and those on the health side speak different languages. What might seem ROI from the health side may not be from the CBO side. But we are all trying to serve the same population whatever you call them (client, resident, or patient),” she said. Jessica Kahn, partner, McKinsey & Company, also said ROI has a different meaning depending on the stakeholder. For example, a board member may be thinking about funding for a new initiative and costs. Community partners may think of ROI as how it improved the lives and health of the people they serve. Sometimes, she said, who sees the ROI is not the person who made the investment.
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Social Determinants of Health Newsletter
How organizations run their programs Three major groups of populations are targeted, Schweitzer said. The most common are high utilizers, patients with chronic conditions, and behavioral health patients. Patients with specific health conditions such as asthma, COPD, or diabetes are less common target populations. The initiatives target diverse social needs (housing, loneliness, nutrition, transportation) and programs look at a variety of drivers to reach their goals. Initiatives offer a broad spectrum of services and supports: • Screening for health-related social needs (94 percent) • Ongoing navigation and support (81 percent) • Follow-up to ensure services were received (69 percent) • One-time referral (66 percent)
• Subsidized social services for individuals (66 percent) • Fund expansion/creation of services for the community (41 percent)
To ensure the programs meet the needs, 88 percent of respondents said that they measure program performance. Most use the following metrics: • Number of patients screened (85 percent) • Number of patients referred (78 percent) • Emergency department/ inpatient utilization (70 percent) • Met Health-related social need (67 percent)
Less common metrics: • • • •
Clinical markers (37 percent) ROI (22 percent) Provider satisfaction (19 percent) Reputation/public relations (15 percent)
Nearly half of the respondents were confident that their programs met their desired objectives: • 18 percent were extremely confident • 25 percent were very confident • 29 percent were somewhat confident • 2 percent were not confident • 17 percent said it was too early to tell • 9 percent did not know
Panel insight: Schweitzer said the survey only scratches the surface of what is going on in the industry and how it is being measured. She said she hopes the results will stimulate discussion to think about how organizations can frame what they want to do, develop activities to address those needs, and how they know whether they achieved their goals. Reflecting on the findings, Kahn said that organizations need to move away from using screening and referrals as metrics and instead have more clear outcome measures that directly reflect whether they have met the goals of the programs. For example, if you have an initiative to address food insecurity, ask your target population whether they felt they had enough food to feed themselves because of the program. “This will be provocative, but screening and referral is so 2008, it’s so 1888, honestly. If you are finding out whether someone has an issue and passing them off to some place, you won’t get to the outcomes we are going for,” she said. Instead, Kahn recommended to be specific about your goals and say exactly
what it is you want to solve. Then ask the at-risk population what it looks for them and design the program to meet those needs. The measure would be whether you achieved it.
...Screening and referral
is so 2008, it’s so 1888,
honestly. If you are finding out whether someone has an issue and passing them off to some place, you won’t get to the outcomes we are going for”
Insight into the impact of COVID-19 on SDoH programs The survey was launched prior to COVID-19 so did not include questions about the pandemic’s impact on SDoH programs. But at the close of the session, Schweitzer asked the panel on whether they thought the outbreak would inspire more investments in programs to address social barriers to health. The overall response was yes. “COVID will hopefully serve as a catalyst to move programs forward,” said Funaro, noting that SDoH needs and demands will continue to ebb and flow and organizations must be ready and willing to adjust to them. As the country moves from stayat-home orders to reopening the economy, she said organizations need to think about job training for people who have lost jobs that may never return. “It’s about really being open to listening and allowing community leaders to have a voice in these discussions.”
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FROM POVERTY TO EMMY AWARD WINNING JOURNALIST HOW JOHN QUIÑONES MANAGED TO DEFY THE ODDS
The ABC news veteran shared his inspiring story during a keynote fireside chat at the RISE National Summit on Social Determinants of Health.
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Social Determinants of Health Newsletter
John Quiñones has connected with audiences around the world as a broadcast journalist, author, motivational speaker, and creator and host of What Would You Do?, a hidden camera ethical dilemma newsmagazine that has made him “the face of doing the right thing” to millions of fans. But the journey to success for the seven-time Emmy Award winner was a long and arduous one, he told moderator Kevin Moore, vice president, policy – health and human services, UnitedHealthcare Community & State, during RISE’s summit.
journalist, he spoke with his teachers and school counselors for guidance, but they suggested he be more realistic and recommended he pursue woodshop or auto mechanics. But Quiñones knew his teachers and counselors judged him on the color of his skin and sound of his accent instead of talent and determination. So, with the encouragement of his mother, he took extra courses through Upward Bound, a federally funded educational program, to prepare for his college education. Quiñones said he got his foot in the door as an intern at a radio station and continued to push forward in his
Born and raised in a low-income area of San Antonio, Texas, Quiñones began his education in the first grade without speaking any English. He developed a strong work ethic early on and when he was 13-yearsold took a job as a shoe shiner. But after his father was laid-off, Quiñones and his family were forced to move to find work. Alongside his father, Quiñones picked cherries for 75 cents a bucket in Michigan and eventually tomatoes in Ohio. “I learned the value of family coming
career. “You just can’t take no for an answer,” he explained. With resiliency and a relentless passion, Quiñones built a television news career of more than 30 years with ABC.
together in times of difficulty,” he said.
forget the poverty and how tough it was. You never forget the comments that were made to you,” he said. “The stories of those less fortunate resonate.”
One morning, Quiñones recalled, he had his knees in the cold ground and miles of tomatoes ahead, when his father asked him if he wanted to do that kind of work for the rest of his life or if he would rather get a college education. From that moment forward, Quiñones knew he wanted more. With the dream of becoming a
Overcoming poverty and racism Growing up in poverty and a segregated city was extremely difficult, noted Quiñones, but he credits the struggles he and his family faced with racism and poverty for his ability to connect with people as a reporter and TV host. “You never
The barriers people of color continue to face due to racism remains a major systemic problem, but Quiñones said he is inspired and encouraged by the actions younger generations have taken to fight for equality. The white community plays a critical role, he explained, to not
just serve as allies but as advocates and activists as well. “We can’t just talk the talk; it’s time we walk the walk.” It is more important than ever to reach out and inspire the young rather than judge a person simply on appearance, he said. Although his success has provided a very different life, Quiñones said he will never lose appreciation for the little things or forget where he came from,. And he still lives by the advice he was once given years ago: “When you’re on the elevator to success and you get to the top floor, don’t forget
You never forget the poverty and how tough it was. You never forget the comments...” to send it back down for the next person,” he said. Quiñones will return as a keynote speaker for the virtual event, RISE National 2020 on June 29-30, where he will deliver yet another inspiring message about reaching one’s highest potential.
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SOCIAL DETERMINANTS OF HEALTH: 3 TAKEAWAYS FROM RISE’S VIRTUAL SUMMIT Client perspectives call for more action from plans and providers, community-based organizations (CBOs) thrive in cross-sector collaboration, and loneliness and mental wellness remain areas of concern. RISE’s virtual National Summit on Social Determinants of Health featured an impressive line-up of leading experts from cross-sector health care organizations who shared firsthand experiences, insights, and best practices to address challenges related to social determinants of health (SDoH). Here are three takeaways from select sessions: SDoH clients need more engagement from plans and providers SDoH clients provided direct feedback around the biggest issues that impact their access to health care during a focus panel session led by Kathleen Ellmore, managing director, Engagys. Eight clients participated in the discussion from 10
Social Determinants of Health Newsletter
their homes in Nashville, Tenn., where the summit was originally scheduled to take place. Although the health plans, client circumstances, and challenges in their daily lives varied among the group, a common theme emerged: Clients need their providers and health plans to provide more outreach. Indeed, all eight panelists said it would be helpful if their health plans reached out more often. Only two out of the eight participants said their health plans have reached out to them to discuss how to overcome barriers outside of health care, and three of the eight said their providers have reached out. Some of the common challenge areas for SDoH clients include food insecurity, cost of medication, and access to care. One client, who had to forego her own medication in order to afford her son’s after an emergency surgery, said outreach from her health plan and
assistance with food or medications would make a significant impact on her and her families’ health, as well as her stress level. The costs of the mortgage, food, and medications have been especially difficult amid the COVID-19 pandemic, she said. “It’s a breaking point; you get tired.” Another client said he struggles with post-traumatic stress disorder (PTSD) and has been unable to meet with his therapist since the onset of the virus. Although he has tried online therapy services such as Talkspace, the panelist said it didn’t feel like the same level of support. “There are some things you can talk to someone about face-to-face more than over Zoom.” Another said she has been unable to afford her medication for depression as the cost has jumped more than $50. If she chose to purchase the medication, she would have to skip meals.
Cross-sector partnerships directly impact SDoH In another panel discussion, CBO leaders emphasized their eagerness to partner with health systems for continued improvements in SDoH. The CBO leadership panel was moderated by Denise Harlow, chief executive officer, National Community Action Partnership. She was joined by Zara Marselian, president and CEO, La Maestra Family Clinic, Inc.; Kristen Daugherty, LCSW, LISW, MBA, chief executive officer, Emergence Health Network; and Sharon Goodson, CCAP, executive director, NC Community Action Association. Panelist said common challenges include billing, dueling electronic health records (EHRs), and funding. Collaboration with health care payers, providers, hospital systems, and others, who are much more wellfunded, would allow CBOs to further their efforts while saving money upstream for the health system.
A great partnership has developed between NC Community Action Association and Duke Energy, explained Goodson. The community action agencies (CAA) collaborated with Duke Energy in 2014 to administer a program to provide energy assistance, helping families in poverty with appliances, repairs, HVAC systems and replacements, and weatherization measures, she said. Duke provided a $20 million investment in the program, which has now increased to $25 million because of the success of the program. Program surveys found families assisted through the program now use less medication, require fewer doctor appointments, have seen an improvement in their asthma and mental health, and report less stress due to work needed in their homes, said Goodson.
Loneliness identified as serious health risk, heightened amid COVID-19 pandemic David Meyers, vice president of stars, Cigna, shared survey results from Cigna’s U.S. Loneliness Index Survey. The findings indicate a concerning number of Americans struggle with loneliness, a SDoH that has increasingly worsened throughout the global pandemic. A common misconception with loneliness is that it occurs to people who are alone, but it happens to people who are around others, too, explained Meyers. Loneliness can develop when people feel they can’t connect in a meaningful way, he said. “Loneliness is not chosen.” In fact, two in five people surveyed were found to lack meaningful relationships, said Meyers. Other factors evaluated in the survey included age, social media use, income, and occupation.
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UPCOMING EVENTS
A RISE Webinar
RISE
Coronavirus Testing A View from the Future Thursday, July 21, 2020 1:30pm Eastern Time
S u m mit
Population November 9 - 10, 2020 Health
Fall 2020
September 9 - 11, 2020
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Social Determinants of Health Newsletter