January 2019 Newsletter

Winter can be beautiful, but also harsh.


Welcome to the monthly newsletter. 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: a federal contract employee whose husband’s life is put at risk by the government shut down; trends and initiatives in western New York, Arkansas and Memphis; the Institute for Medicaid Innovation report on social determinants and Medicaid Managed Care; A Health Affairs blog and Lund Report opinion on why current approaches to addressing living conditions are not enough; CVS and Kaiser investments; The two way relationship of public housing authorities and healthcare providers and insurers; two data initiatives — the SHELI project and Casenet’s integration of community services for Medicare advantage; The #1 JPMorgan takeaway and the NQF and Aetna foundation project to identify scalable approaches for improved living conditions.

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

A personal story

I’m sure there are many personal stories in which the government shut down created living conditions that quickly had a negative impact on health. The Congressional Budget Office estimated it cost the US economy $11 Billion dollars, in some respects this masks what it does to individuals and families, as is evident in Janice Morgan’s story, a federal contractor who lost her health insurance and thought she may lose her husband because she could not afford his medication. Even as contractors return to work, wages and insurance are still in limbo.

Community Initiatives

Western New York – the health and wellness industry is the biggest employment sector in the region – Some of this growth was due to poor county health ranking and some of the growth targets healthy aging and helping needy patients. Is this the future for all of the U.S.?

Arkansas wellness centers in schools offer ways to enable early intervention for illnesses and can help identify and address living circumstances that affect students and their families.

Memphis Breast Cancer Consortium is working to address breast cancer disparities between black and white women in Memphis. “Although white women are diagnosed with breast cancer more often, black women in the Memphis area are dying at a much higher rate.”

Government Initiatives Federal and State

The Institute for Medicaid Innovation published a new report on opportunities for Medicaid Managed Care to address living conditions for the most vulnerable population in the United States. The report provides: an overview of the policy landscape; a characterization of barriers including data exchange; screening resources; and, four examples of states or communities addressing social needs in Medicaid: North Carolina, D.C., Michigan and Mercy Care in Phoenix.

Mediating living conditions is necessary but insufficient. Health Affairs blog underscore the need for policies to address the underlying causes of inadequate living conditions.

Health System and Community-based Services

CVS commits to $100M investment in social determinants. Kaiser invests $5.1 million (part of its $200M investment) in affordable housing to help combat homelessness.

 A recent Forbes article highlights that Public Housing Authorities are seeking closer ties to healthcare insurers and providers to partner around needed health services and needed community services supports including low-cost housing.. “Recent research shows that housing is both a social determinant of health and a platform for other services that improve life outcomes”.

According to Dan Michelson, CEO, Strata Decision Technology, the #1 takeaway from JPMorgan “…for healthcare providers, there is a major shift taking place. They are moving from a traditional strategy of buying and building hospitals and simply providing care into a new and more dynamic strategy that focuses on leveraging the platform they have in place to create more value and growth via new and often more profitable streams of revenue.” Specifically, healthcare leaders feel an urgency to leverage their platforms to become the hub for health and healthcare in their community due to fear of someone else stepping in.

Research, Metrics & Technology

Community health versus population health – this Lund report opinion piece suggests that we cannot address the health of a community in a similar way to medicine or population health because we are not using the right observational tools. We need to use network science:

“By mapping relationships between the various relevant nodes in a community (people, organisms, ideas and things) and tracking each node through time, relational analytics can provide quantitative data about how elements in a community dynamically respond to events and each other.”

National Quality Forum and Aetna Foundation team up to identify successful and scalable programs that improve living conditions.

The SHELI project went online last week. It provides data on seven categories, including the density of fast-food restaurants within a mile, the availability of doctors and dentists, access to supermarkets and walkability.

Casenet is enabling easy integration of community-based services for Medicare Advantage plans. The Trucare population health management platform facilitates incorporation into more comprehensive care plans.

Shannah’s Insights

Predictions of what’s to come in 2019 and summaries of what was hottest in 2018 are everywhere. No matter where you look the conditions in which we live work and play i.e., social determinant in the health policy world, were and are top priorities and trends. Unfortunately, the vast majority of success stories and initiatives are being driven and determined by the health systems versus the communities that ultimately need to embrace and support needed change.  

The statistic about western New York could be the future for all of the U.S. if we continue to follow the Pac-Man model of healthcare, i.e., all things relating to health become part of the clinical health system.

The SHELI project intersects with the caution from the Health Affairs blog. The tool will give you granular info on the neighborhood, but then what gets done about it. The poorest individuals have the least ability to change their surrounding living conditions.

In almost all of the activities and reports, directly engaging the individuals in the solutions and initiatives is often a missing piece of the puzzle. Let’s hope it is happening more often than the coverage implies.

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.


HIMSS2019, February 11-15 Orlando FL has 18 sessions that discuss some aspect of social determinants of health largely using data to address SDOH. Many exhibitors also focus on SDOH including the interoperability showcase.

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.

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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