2019 Year-end Newsletter

Wishing You Peace, Health and Happiness


Welcome to my 2019 year-end newsletter and some aspirations for 2020. You can find past newsletters with additional background materials, and different stories and initiatives in my LinkedIn articles and on my website. Join me in improving and coordinating initiatives that advance health, health equity and community and healthcare redesign.

This month you can read about: Forbes 8 solutions for improved living conditions; West Virginia’s sustained community improvement; Humana’s no senior eats alone; ChristianaCare’s community investment; states finding the right balance between social and health investments, Don Berwick’s thoughts on change from within the healthcare system; and CHIME’s concerns about the no-blocking rule.

Shannah’s Insights and Reflections

I’m taking a slightly different tack for this year-end newsletter and just sharing my general thoughts versus perspective on the bulk of this month’s activities.  As always, we’re seeing lots of predictions for 2020. Most Social Determinants of Health (SDOH) predictions anticipate there will be more talk than action. I’d like to challenge all of us to prove these predictions false and seek to achieve the following:

  1. Develop and implement collaborative community-wide models and initiatives that invest independently in improved socials services and community infrastructure.
  2. Measure the impact of these models and initiatives with quality of life metrics in addition to clinical care outcomes, for example:
    • Can we stem the downturn on life expectancy?
    • Can we increase percentage and length of active life for the aging population living in communities of choice?
    • Can we reduce loneliness across the lifespan?
  3. Give these new models and initiatives some runway to demonstrate their impact. At least until 2025, if not 2029!

A few articles and research are surfacing asserting that the US has comparable investment in social and community infrastructures as other economically developed countries. I believe these assertions are living in the same world that wants to overstate health care system investments in the communities.  

I applaud ChristianaCare’s $2M investment, but it is $2 per resident and $62.5 K per community organization. Meanwhile, Delaware’s per capita healthcare expenditure in 2017 according to CMS was $10,254 and only going up.  If we believe most healthcare outcomes and health status are drive by the impact of SDOH, i.e., 60%-80% then let’s move to more equitable investment. As a small state, DE could lead the way for a new model with a broad set of stakeholders including ChristianaCare investing in needed improvement!

Share your personal or community stories by connecting via LinkedIn or email kossoncare@starpower.net I welcome suggestions in all topic areas, particularly community driven models.

A personal story

No story per se, but a wish. As we head into a new decade, I hope all of us have a chance to reflect on what is positive in our lives and communities and commit to helping friends and neighbors have community supports and opportunities to live healthier lives.

Community Initiatives

Forbes article 8 SDOH solutions

  1. Improve diets and access to healthy food
  2. Improve physical environments such as housing, transport, parks
  3. Improve access to the Internet
  4. Better understand care needs and bring care to them
  5. Integrate healthcare with retail
  6. Use technology to bridge the gaps
  7. Restructure financial incentives to motivate actions
  8. Change the focus of healthcare

In her new role, Elaine Darling primarily will focus on developing and expanding The Center for Rural Health Development’s newest initiative — Wild, Wonderful & Healthy West Virginia, which is focused on creating long-term sustainable improvements in the health of our communities.

Humana hosts  an event, “No senior eats alone” at their Kissimmee neighborhood center.

ChristianaCare Health System launches  a $2M community investment fund in collaboration with 32 local nonprofits in Delaware.

Background on community investments and initiatives outside of healthcare

Look for more entries next month.

Government Initiatives Federal and State (national initiatives)

Health Affairs Blog, Health Conundrum: How State Budgets Can Find the Balance Between Social Versus Medical Services, discusses the uncertainties behind the shift in investments to social services and the sustained challenges in healthcare spending including ~20% of waste. It recognizes global budgeting efforts including the successful savings under the State of Maryland’s Medicare Waiver and encourages multi-stakeholder efforts to plan needed community social services with a shift in funding and focus. It also emphasizes that society may not value the shifted investment sufficiently to make it happen.

Health System and Community-based Services

Don Berwick from the Institute for Healthcare Improvement emphasizes that for change in health systems to happen we need to recognize and embrace the reality of the impacts living conditions can have on health and to start with internal change. “Instead of arguing for higher hospital reimbursement, which is their main agenda, how about arguing for proper distribution of social investments in causes of illness,” 

Research, Metrics & Technology

College of Healthcare Information Management Executives (CHIME) writes to Congress saying the rule designed to stop data blocking will leave patient data vulnerable and creates an uneven playing field.

Please share the newsletter and connect via LinkedIn or email kossoncare@starpower.net with your reactions and input.


eHi & wedi Working with Government to Advance SDOH, Tuesday, February 4, 2020 | 8:30 am – 5:00 pm

RISE National Summit on Social Determinants, March 15-17, 2020 Nashville there is a virtual attendance option.

Background and Definition

I have chosen the phrase “Living Conditions” rather than social determinants of health (SDOH) to make the concept more accessible.  This focus tracks with the Centers for Disease Control and Prevention’s SDOH definition “as conditions in the environments in which people live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”

Go here for more information from CDC on its organizing SDOH framework in Healthy People 2020

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