SDOH Newsletter - Summer 2021 by WilmingtonFRA

OUR 2021 SUMMIT Highlights and takeaways

SDOH AS QUALITY INITIATIVE Health plan case study

ACHIEVE TRUE MEMBER CENTRICITY 3 targeted SDoH approaches

nº6 - Summer 2021

THE LATEST NEWS

COVID-19 interrupts global poverty decline

Mental health services wane as insurers appear to skirt parity rules during pandemic

Study: 5-Star ratings don’t necessarily mean all MA members receive top-level care

SDoH in the news: HHS announces actions to improve maternal health; Blue Cross Blue Shield sets goal to reduce racial disparities

HHS announces water assistance program for low-income households

Blue Cross NC launches prevention programs to address food insecurity, nutrition

In Missouri and other states, flawed data makes it hard to track vaccine equity

SDoH in the news: The impacts of COVID-19 one year later; NIH to address COVID testing disparities in vulnerable communities; and more

SDoH in the news: CHWs reduce hospital readmissions; U.S. hospitals ranked on racial inclusivity; and more As pandemic eases, many seniors have lost strength, may need rehabilitative services Latinos are the most eager to get vaccinated, survey shows — but face obstacles Horizon Blue Cross Blue Shield of New Jersey finds success in SDoH pilot program, expands community partnerships

Pandemic brings digital inclusion to light as critical SDoH

Survey reveals frontline health care workers face serious mental health challenges due to pandemic SDoH in the news: US aims for an equitable vaccine rollout; Medicare beneficiaries struggle to manage chronic conditions due to COVID-19; and more

READ OUR ENTIRE COLLECTION OF INSIGHTS AND ARTICLES 2

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Letter From the Chair

2 TAKEAWAYS FROM THIS YEAR’S RISE SUMMIT ON SOCIAL DETERMINANTS OF HEALTH RISE’s annual Summit on Social Determinants of Health was hosted as a hybrid event this month, and while I was excited to attend my first in-person conference event since March 2020, the sheer exhilaration of all that is occurring in the SDoH space really got me going! For those who attended, whether you participated in-person or virtually via livestream, you were part of the premier SDoH event of the year. For those who may have missed it, check out the highlights recap (page 8). My conversations with attendees from across sectors yielded one clear message: The time for action is now. There is abundant data to validate the human, fiscal, and clinical costs of health and mental health disparities. The return on investment for SDoH and SDoMH programs is massive. However, to follow the words of our keynote speaker, International Bestselling Author and Professor Dr. Jonah Berger, it is time to “reduce the roadblocks and act as catalysts for change.”

Shared collaborators and activators The collaborative discussions ignited at the summit will continue during our monthly SDoH community user group meetings. With more then 1,500 community members, we span every sector, and

together we’re developing sound transformational program and processes to mitigate care gaps. We have become collaborators and activators of change. The willingness to participate in these conversations to guide each other is incredibly novel. Everyone is committed to one common goal: Mitigate those gaps in care that impact all persons in need. Independent of the sector, the same language echoed through conference space, “let’s just get it done.”

scheduling an SDoH Policy and Funding Summit in the District of Columbia so stay tuned for more information. If you’re interested in the idea, email Marina Adamsky at madamsky@risehealth.org. I could clearly go on, but I’ll keep this column brief. For now, share all that is happening in our SDoH community with those you feel would be interested. Stay safe and take good care!

The road ahead is paved with strategic action As far as this community has come, a great deal of work is still necessary to bridge those gaps. Necessary legislation and funding to advance sustainable SDoH solutions are the current mandate. Our SDoH community funding list remains available to you as a comprehensive guide for funding efforts targeting SDoH. Look to our SDoH community to develop an arm focused on the vital domains of public policy, funding, and community investment. These dedicated areas must be advanced to develop sustainable SDoH solutions. You will see an increased focus in upcoming newsletters on pending and relevant legislation, revenue streams, and other financial information of interest. Many community members have expressed interest in

Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CCTP, CMHIMP, CRP, DBH(s) Social Determinants of Health Community Chair The RISE Association

RISE SDoH Community Exclusive: Funding opportunities targeting social determinants of health CLICK TO SEE OTHER ARTICLES

How one health plan improved member engagement, Stars, and quality performance by addressing SDoH

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Here’s how UnitedHealthcare, a health insurance plan with benefit programs for individuals and families, employers, and Medicare and Medicaid beneficiaries, leveraged social determinants of health (SDoH) programs to better meet member needs, improve Star ratings, and close quality and HEDIS® gaps. Recognizing the significant impact social determinants have on member actions, decisions, and health outcomes, UnitedHealthcare embarked on an SDoH journey to identify social needs in members and increase participation in programs. “Having to think about things like housing instability, food insecurity, transportation, it can take up a lot of mental energy and strain your ability to engage in your health and live your best life,” said Alexander Billioux, vice president, social determinants of health, UnitedHealthcare, during last week’s RISE National 2021 virtual event. It was also an opportunity for the health plan to focus on Star ratings and close quality and HEDIS gaps, he said. “Care gaps are really critical for both the member’s health journey but also for us as a plan to demonstrate our care management is providing value, so meeting these needs has a dual benefit for the plan ourselves and, most importantly, the member.” UnitedHealthcare leveraged a variety of SDoH programs, some directly to members, others in partnership with providers, to learn more about their membership and how the health plan could best support them. The SDoH efforts include in-home visits, call centers, clinical teams, dual-enrollment, and referral management programs. In-home visits generate some of the most insightful information, according to Billioux, noting the appointments offer an inside look at members’ environments, barriers they may face, and other health-related social needs that a brief screening questionnaire can’t uncover. The in-home visits also provide a comfortable environment

for members to discuss sensitive topics related to their social needs.

Data collection, analytics is key To collect and manage SDoH data on their membership, UnitedHealthcare partnered with Change Healthcare, a health care technology company that provides data and analytics solutions and services. The collaboration allowed the health plan to gather membership data using artificial intelligence (AI) as well as incoming referrals from programs, such as in-home visits. The data helped the plan identify members with social needs and then determine the appropriate outreach and SDoH program.

which ensured that the health plan could close the loop and follow-up on whether the referred community resource was helpful to members. Billioux said that since implementing the SDoH programs, UnitedHealthcare has conducted more than 1.8 million screenings in 2020 and identified approximately 30 percent of members who have a social need, with two-thirds of those individuals accepting referrals. The health plan, he said, continues to learn how to better leverage that information, identify members, and close gaps during the screening process.

The dual-identification not only allowed UnitedHealthcare to find more members struggling with SDoH, but it also enhanced dual-eligible enrollment, member engagement, and retention,

“Having to think about things like housing instability, food insecurity, transportation, it can take up a lot of mental energy and strain your ability to engage in your health and live your best life,”

explained co-presenter Jim Bridges, senior vice president, government services, Change Healthcare. Indeed, he said, simply addressing the need of members made them much more receptive to discussions around their dual status. “We found members tend to stay much longer, have much better retention, and a much better impression of their health plan once we’ve engaged them around their needs related to SDoH,” he said. “It’s one of those places where what’s good for the health plan and good for the member have perfectly lined up.” UnitedHealthcare also relied on the company’s referral management system, CLICK TO SEE OTHER ARTICLES

How to achieve true member centricity with a grassroots approach Here’s how three organizations targeted social determinants of health (SDoH) and accomplished improved health outcomes beyond the clinical walls.

and we really want to impact the SDoH realm of our world, however, in order to do so there’s a lot of silos to be broken down, there’s intense levels of communication and transparency that need to happen,” said Magrane.

During a live-streamed conference session led by Signify Health at the RISE National 2021 virtual summit in March 2021, panelists shared the innovative solutions their organizations have implemented in their respective markets to achieve true member centricity.

In addition to increasing collaboration, AACN aims to identify patterns in client needs, capture SDoH, reduce duplication of efforts, identify gaps in services for unmet needs, and gather cross-sector evidence.

Kronkosky Charitable Foundation’s Alamo Area Community Network (AACN) Cara Magrane, director of initiatives and partnerships, Kronkosky Charitable Foundation, shared the initiatives of AANC, a community referral platform, to bring together community-based organizations (CBOs), payers, providers, and funders in the Signify Health platform to impact the wellbeing and health of the San Antonio community. AACN goes far beyond just an electronic referral platform, said Magrane. The community network strives to cultivate a deeper level of collaboration between nonprofits and funders to ensure CBOs and nonprofits, who have long addressed SDoH, have a voice at the table due to their critical work that has a fiscal impact on the community and health systems. “Often, we’re very well intentioned as stakeholders, whether we are funders, or community-based organizations, or payers, 6

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The community network also seeks further funding for community organizations. While organizations are currently funded through grants, the money is not robust enough to impact bigger system change, causing CBOs to remain dependent on funders, state systems, and local systems, she explained. To provide another source of income for organizations solving for SDoH, AACN aims to implement and impact Centers for Medicare & Medicaid Services (CMS) billing codes to ensure resources funnel down to CBOs. While AACN just launched in September 2020, it could not have come at a better time amid the COVID-19 pandemic. As part of the San Antonio’s community recovery resiliency plan, the city was mandated to create an electronic platform for CBOs to connect people to services, which AACN was promptly able to provide, allowing the city to amplify and onboard an additional 50 organizations.

Humana’s Bold Goal To double down on its commitment to improve the health of its members, Humana launched its Bold Goal strategy in a handful of selected markets, starting with the San Antonio community, which led to a collaborative partnership with the AACN and Signify, explained Jackie Rivera, population health strategy lead, Humana. The goal: To improve the health of the communities Humana serves 20 percent by making it easier for people to achieve their best health. “We’ve learned the significance of looking at social and economic factors and what impact those have on a person’s health. So, if 60 to 80 percent of what makes a person healthy is impacted by nonclinical factors, we have to look at the whole picture,” she said, noting the priority to focus on the integration of clinical and social care in the same ecosystem became very obvious. “Humana realized and recognized it wasn’t enough to just support community work as they address social health, but we really needed to look internally at our own workflows and processes and operations to figure out what we needed to do to change in order to be part of that conversation.” In its approach to address social health, Humana sought programs and interventions that incorporated a social health lens to the work they do on an enterprise level. Six years after launching the Bold Goal strategy, the health plan has expanded to 16 communities, and by 2020 conducted 3.5 million SDoH screenings, provided 816,000 more healthy days for Medicare Advantage (MA) members in Bold Goal communities, launched strategic academic partnerships to support physicians, and delivered more than 1.1 million meals from March 2020 through the end of the year as a response to the COVID-19 pandemic. Additionally, to ensure a closed-loop referral system, Humana launched its Social Health Access Referral Platform (SHARP) project, a technology that allows care coordinators to screen for SDoH, better connect members to community resources that address social health, and then understand the impacts on members’ clinical health outcomes, explained Rivera. Through its partnership with the AACN and Signify, Humana was able to implement SHARP throughout the San Antonio community. Rivera credits Humana’s partnership with the AACN and Signify for the progress made so far. “We can’t do it alone; so, health care can’t drive this change just within the health care segment, community can’t drive that change just within the community segment,” she said.

Independence Blue Cross’ CommunityLink Similarly, Independence Blue Cross launched its CommunityLink network in partnership with Signify in June 2020 to connect community organizations that aim to address SDoH in the Philadelphia area. As one of the poorest major cities in the United States, Philadelphia has many challenges, including SDoH, said Julia Weatherly Sr., GM Stars program analyst, Independence Blue Cross, noting many people struggle with social issues beyond financial restriction. “People knew SDoH existed in Philadelphia, but people weren’t so convinced that they existed for people who had private insurance.” Recognizing many of its Medicare members weren’t compliant with care measures such as mammograms or colonoscopies due to SDoH, Independence Blue Cross aimed to address the social and economic factors members faced. By developing its own SDoH questionnaire, the health plan was able to gain a deeper understanding of members’ social needs. The CommunityLink network currently consists of 16 organizations, composed of smaller and local organizations as well as those on a national scale. These organizations are among those that Independence Blue Cross Medicare members would be likely be referred to as well as the organizations that the community turned to in times of need, said Weatherly. “As we work through our members and we assess their needs, we’re starting to understand just how diverse people’s needs are in the Philadelphia area,” she said, noting the launch of CommunityLink amid the pandemic brought key social issues such as loneliness and mental health to light. So far, the community network has identified 3,200 needs and made 2,200 referrals to local organizations. In addition to supporting the people throughout the Philadelphia community, CommunityLink also aims to support the organizations, said Weatherly. “We really want to understand the needs of our community organizations and find ways that we can support them in either opening up and doing more services or what they need kind of on the back end, what they’d like to see from the platform, how we can enhance their overall processes to help people in the communities.

“This approach truly does allow us to keep the member at the center of everything we do because we’re untangling this current disconnect our members face when it comes to achieving their best health. Instead of putting responsibility on members to seek assistance and guide their own path, through the partnership with AACN and Signify, we are better able to direct our members to community resources.” CLICK TO SEE OTHER ARTICLES

The RISE Summit on SDoH recap:

becoming a change agent, new financing model, & what’s happening on the Hill

SDoH COMMUNITY NEWSLETTER

It was a powerful two days at The RISE Summit on Social Determinants of Health! After a long 16 months, some attendees experienced a thrilling return to in-person attendance in Nashville, and others joined from the comfort of their home offices thanks to our reimagined hybrid conference experience. If you missed it, we’ve gathered the highlights for you. Empowering keynote address to change anyone’s mind

The conference kicked off with an empowering keynote address from International Bestselling Author and Professor Dr. Jonah Berger on how to change anyone’s mind. As a world-renowned expert on change, word of mouth, influence, consumer behavior, and how products, ideas, and behaviors catch on, Dr. Berger shared his insights to change someone’s mind to cultivate cross-sector partnerships across the health care ecosystem and gain internal buy-in for new pilots and programs. Dr. Berger, marketing professor at the Wharton School at the University of Pennsylvania, said it’s important to remember that the more we push for change, the more likely people will resist and do the opposite of what we want them to do. For example, telling people what not to do often makes them do it as we’ve seen with the number of Americans who

Too often we state what we want to happen, but people don’t like to do as they are told. Instead, ask them what they think.

are hesitant to get the COVID-19 vaccine or wear masks. Change is hard for people, he said. But it is possible to get people to change their minds without providing them with more facts and figures. Because people have a “status quo bias” —the tendency to stick with what they know and do already because it’s familiar and safe—it’s important to think like a chemist and find a catalyst to lower the barrier to change. People need to feel like they are in control and might make the change if they feel as if they came to the decision on their own. To help give them this freedom and control, Dr. Berger suggests you: Provide a menu of options: Don’t give people one option. Give them a guided choice of limited choices like a menu at a restaurant. By providing options, it gives people the feeling they are in control, and they won’t focus on the choices not before them. Ask, don’t tell: Too often we state what we want to happen, but people don’t like to do as they are told. Instead, ask them what they think. For example, he said, the founder of a start-up company couldn’t rally his team to stay late and work weekends to meet a deadline. So, he called a meeting and asked the team whether they wanted to work for a good company or a great company? When the team said a great one, he asked them, how do we get there? By asking questions, rather than making a statement, it allows people to arrive at the right answer and makes them feel like they are participating in the solution. If they came up with the solution in the first place, it makes it difficult for them to resist the change. Highlight a gap in attitudes and actions: People typically want their attitudes and actions to line up. For example, if they say they care about the environment, they will recycle. But sometimes they are inconsistent, and you can show how their attitudes and actions don’t match. To illustrate his point, Dr. Berger showed a commercial made in Thailand of adults smoking and children approaching them asking for a light so they could also smoke a cigarette. All the adults refused to give them a light, stating that smoking is bad for their heath. The

children then handed them a note and walked away. The note asked why they are still smoking if it is dangerous. As a result of the exchange, 40 percent of the adults approached quit smoking. “They had all the information,” Dr. Berger said. “They knew it was dangerous for their health. Too often we think information is the problem. It is very rarely. They solved the problem by finding a gap of where their attitudes and actions don’t line up.” Allow people to experience the benefits before they incur costs: We usually ask people to pay for something upfront before they know for sure that a product or service will make their lives better. There are always some costs to change but the benefits are uncertain. Uncertainty is great for the status quo, but not good for change, he said. Instead, lower the barriers to the product or service by offering “freemiums” or a trial to try the product or service before they upgrade to the premium option. It’s like renting before buying. “It’s easier to experience the value of the offering without paying the upfront costs. You are more likely to convince them…They are more likely to try it and more likely to buy it.” The same is true with a pilot program. First, he said, find the roadblocks and then figure out how to mitigate them. “It’s not luck and chance,” Dr. Berger said. “There is a science why people change and why they don’t. If you understand it, you can build better programs and be better change agents.”

A look at a new innovative financing model

Len Nichols, Ph.D., non-resident fellow, Health Policy Center, Urban Institute shared an insightful spotlight on a new financing solution and upstream economic model that works. Throughout the presentation, Nichols shared an in-depth look at how to utilize a Collaborative Approach to Public Good Investments (CAPGI) as a sustainable financing tool for communities to improve health and wellbeing, create a stronger community, and lower costs, all while addressing the free rider problem. CLICK TO SEE OTHER ARTICLES

As a solution to the public good and free rider problem, Nichols and his colleagues developed the CAPGI model, which aims to make upstream SDoH investments sustainable by establishing a trusted and fair financing system. Following the CAPGI model, stakeholders will only communicate with a designated trusted broker regarding their “bid,” the amount they are willing pay toward the initiative. Based on the funds offered by each stakeholder, the trusted broker then assigns fair prices to each stakeholder so that any surplus beyond the total cost of the initiative is shared. All contributions and sustainability are based on enlightened self-interest, noted Nichols.

President Biden’s FY2022 budget request also includes more potential funding for SDoH, including:

To make upstream SDoH investment sustainable, the model also includes two “fairness constraints,” explained Nichols: 1. No one pays more than they bid, and everyone shares in the surplus. 2. Each stakeholder shares the available surplus in equal proportion. Since sharing the CAPGI model publicly, Nichols and his colleagues have heard from communities across the country wanting to implement the innovative solution. After conducting a serious application process, Nichols and team selected 10 of the most promising applicants to help implement the CAPGI model within their communities between 2020-2022. “We realized we touched a nerve,” he said. “The truth is, there’s a hunger, a sense of urgency that we have to figure out as a country how to deal with upstream activities that have been underinvested in for so long.”

An update on what’s happening on the Hill

Melissa Quick, co-chair, Aligning for Health connected the dots on SDoH during a deep-dive update on what’s happening on the Hill. Throughout her presentation, Quick stressed the importance of addressing SDoH to improve health while noting some of the challenges encountered when trying to do so (including inflexible funding and data silos, disconnected programs that are at difficult to navigate, and disjointed communications that may 10

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“There is a lot of interest in addressing social determinants, particularly from the Biden administration, to really advance health equity,”

lead to referrals to organizations with little capacity to help). She explored current congressional approaches to address SDoH, including increased funding and legislation, as well as funding for SDoH programs within the American Rescue Plan Act and the Consolidated Appropriations Act. So far, she said, the 117th Congress has seen lawmakers introduce 61 bills focused on SDoH. Quick also delved into major health equity/SDoH packages of 2020-2021 (28 bills are focused on health disparities/equity and 59 bills address maternal and infant health).

• $153M to the Centers for Disease Control and Prevention’s SDoH program, a $150M increase over 2021 enacted level • $200M to reduce maternal mortality and morbidity through a number of initiatives • $25M to the Centers for Medicare & Medicaid Services to address health equity, including by taking steps to fulfill President Biden’s equity executive order • $551M for home or communitybased health care services, increased funding for the Lifespan Respite Care Program, and other programs for older Americans and individuals with disabilities • As for the likelihood of the funding to actually be included in the 2022 budget, Quick said there is no guarantee, but she is optimistic. She sees a growing interest in legislation that would fund and coordinate health equity initiatives to make sure individuals don't fall through the cracks and there are no barriers to access the programs. "There is a lot of interest in addressing social determinants, particularly from the Biden administration, to really advance health equity," she said. "The challenge is exactly how to do that and have it be bipartisan. Even though Democrats control the House, Senate, and White House, it's a razor-thin margin and they are trying to define avenues for legislation forward that is bipartisan."

Dr. Berger, marketing professor at the Wharton School at the University of Pennsylvania

A virtual panel discussion on working handin-hand to serve vulnerable populations

The last session of the day to connect the dots on SDoH during a deep-dive update on what’s happening on the Hill from Melissa Quick, co-chair, Aligning for Health

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UPCOMING EVENTS SDoH User Group July 20th, 2021 - 1:00 pm – 2:00 pm EST

Risk Adjustment in a Value-Based World July 22nd, 2021 - 1:30 pm EST

LEARN MORE ABOUT USER GROUPS