February 2019 Newsletter


Welcome to my February 2019 monthly newsletter. This marks the beginning of my second year sharing an overview of what is happening at the intersection of health care and living conditions also known as social determinants of health. You can find past newsletters in my LinkedIn articles and on my website. They have some additional background materials with different stories and initiatives that might be of interest. My goal for the newsletter is to inform improved and coordinated initiatives that advance health, health equity and community and healthcare redesign.

This month you can read about: Funerals spurring some thoughts on living conditions; health screening and education in barber shops and salons; SIPPRA a Treasury program funding state and local government investment in social impacts; CMS’s efforts to minimize financial impacts; North Carolina’s move to managed care; initiatives from Lyft, Blue Cross Blue Shield Institute, HealthBegins and AHA’s Physician Alliance; and, the breadth of sessions and announcements a HIMSS annual conference.

I’m changing the format to move my insights to the beginning of the newsletter, please share your reactions.

Shannah’s Insights

Community is a critical concept in many of this month’s topics. Whether it is the family and friends who come together at a time of loss, the community that gets formed in barber shops and salons that can embrace health screening and education or the community partnerships needed to enable virtually all programs to address poor living conditions, we need mechanisms that create and sustain community initiatives. Food programs are a great example of these partnerships and are expanding across communities. FoodQ is an interesting example where it is not tied to being part of a healthcare program and could have broader health improvement impacts.

I’m relieved to see Treasury’s SIPPRA program as one of the first federal initiatives not just looking to repurpose healthcare dollars. It is a reasonable amount of initial funding to see how these types of programs could impact federal spending across health and social service programs while improving living conditions.

CMS continues to try to leverage consumer awareness regarding pricing as a means to control spending. It is a great option when consumers have affordable alternative treatments but puts patients at risk when the non-covered product or treatment is the only option for a particular patient. An app that also helps navigate how to appeal or gain consent for coverage when it is your only option would have greater value for health and savings.

Kudos to HealthBegins and AHA Physician Alliance for providing free training modules. I have not watched all the modules and would love to hear from those who have what they think.

The many HIMSS sessions and announcements highlight that technology is trying to keep up with the growing demands of improving living conditions and helping the clinicians and the community organizations better engage and manage. To date, most technologies have been more heavily focused on the clinical care side, but that appears to be slowly shifting.

The ONC and CMS rules designed to eliminate data blocking for consumers is long overdue and a critical step in timely access to our own health records. The final rules getting published in time to set a 2020 deadline is very uncertain. The industry has consistently pushed back on consumer access. The goal of consumer access was established when HIPAA first passed in 1996 then re-emphasized in HITECH. It has even greater importance as data about living conditions (social determinants) is increasingly collected. Although patients may never own their health records, we are entitled to all of the information that health systems and insurers have and use to provide care and payment, with a few legal exceptions. It is necessary to help us understand our health, navigate the still fragmented care system and determine whether we want the information shared beyond what is required for treatment and payment.

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

I recently went to two funerals.  One was for a woman who was diagnosed with schizophrenia in the late 50’s or early 60’s and struggled most of her life but found some peace at the very end. The other was for a woman who died unexpectedly, was a beloved teacher, friend and mom; her loss shook the family and a community.  Both funerals highlighted how peoples’ lives are intertwined, have substantial impacts and are shaped by their circumstances.  The funerals themselves highlighted how important it is for communities to gather to recognize and honor the person who passed while supporting all of the people who are grieving. Although these two women had very different paths their families were well held in an inevitable, but hard part of life. Perhaps extending that support more readily while we’re all living is a key part of better living conditions.

Community Initiatives

ProMedica’s barbershop health program is bringing health screening and education to barbershops and salons.  This program, similar to ones around the country, is a great example of meeting people where they are and acknowledging that comfortable social environments can help people better engage in their health.

Government Initiatives Federal and State

“The Social Impact Partnership to Pay for Results Act (SIPPRA) was signed into law on February 9, 2018 and is intended to improve the effectiveness of certain social services. The federal government will pay for a project only if predetermined project outcomes have been met (vetted) and validated by an independent evaluator, a system called a “pay for results partnership.” Congress appropriated $100 million for the SIPPRA program to implement “Social Impact Partnership Demonstration Projects” and feasibility studies to prepare for those projects. “

The list of 21 outcomes, the 21st allowing flexibility for the state or local governments to define a project that has a positive social outcome and federal savings, addresses the vast majority of living conditions that impact health outcomes. The program has a preference for outcomes for children and low-income families.

CMS seeks to address senior poverty in Medicare through price transparency and a “What’s covered” app.  The goal is to help Medicare beneficiaries know what medications and treatments cost. The What’s covered app is intended to help patients and families know if something is NOT covered so that the cost does not put them at financial risk.

North Carolina, one of the 12 remaining states without managed care plans, moves to Medicaid managed care with an emphasis on healthy communities. “The managed-care organizations will be required to screen every Medicaid beneficiary for insufficient access to food, lack of stable housing and transportation and exposure to interpersonal violence. The plans will then need to connect beneficiaries to organizations that can help find needed services.

Health System and Community-based Services

Lyft expands support for Medicare Beneficiaries. “We extended this offering in 2018 to include rides to and from pharmacies for prescription medication pick-up,” the company explained.

“And now, with the new benefit design flexibility in MA, BCBS Institute will expand the partnership to members of certain BCBS MA plans beginning later this year — providing rides to-and-from medical appointments, the pharmacy and fitness centers. This is big news for seniors, as Lyft is able to provide transportation for a broader range of health needs.”

Health Care Services Corporation and Blue Cross Blue Shield Institute announced a six month pilot service for food deserts called FoodQ. It is starting in 25 zip code areas in Chicago and will expand to 15 zip code areas in Dallas. It is available to all consumers in the zip code area, and if they subscribe they get free delivery and two meals for $10 any time they order. The goal is to provide healthy meal options to people who have limited options and often struggle with obesity and chronic illness.

HealthBegins and AHA Physician Alliance developed 5 free training modules for clinicians and community partners on social determinants/upstream quality improvement. Three of the five modules concentrate on food, housing and transportation.

Research, Metrics & Technology

Patchwise Labs, reported that there were 48 presentations and exhibitors on Social determinants and Health at HIMSS. There were also a number of announcements relating to SDOH/living conditions. Here are some snippets:

Innovaccer Releases Healthcare’s First Ever Research on Social Determinants of Health with Zip Code-Level Insights Across the US – goes beyond CDC’s more simplistic approach with a proprietary algorithm. They also released a research paper called “From Myth to Reality – Revolutionizing Healthcare with Augmented Intelligence and Social Determinants of Health”

Salesforce announced it is getting into home healthcare and SDOH, their homecare clients will be able to track social characteristics along with other information in the customer relationship management system.

HHS announced the release of the long-awaited information blocking rules designed to help patients more easily access their own health information. There are incentives and requirement for using data formats and application program interfaces (APIs) that will facilitate timely access to health information. The proposed rules have been published for public comment and will then be finalized with revision based on the comment. The deadlines for meeting certain requirements is 2020 thus the expectation is they will finalize the rules in mid-2019.  CMS’s rule can be found here and ONC’s rule can be found here.

In other news, a proof of concept program for food insecurity screenings is being rolled out in New York,  “Public Health Solutions has partnered with Unite Us, which provides social determinants-focused software, to enhance care coordination for its Food and Nutrition Services Bundle program and to track the program’s outcomes.”

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


2019 Annual Conference of the America Society on Aging April 15-18 Hyatt Regency New Orleans, participate in our panel and discussion on Healthy People 2030 starting at 3:30 on the 17th.

Social Determinants of Health Symposium,June 6 Cleveland Ohio

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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