January 2020 Newsletter

Apparently Punxsutawney Phil says winter will be shorter this year!


Welcome to my first 2020 newsletter. 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: Community Care Corps; Lyft’s grocery access program; strengthening Human Services; Medicaid block grants, the public charge rule; the proposed Social Determinants Accelerator Act; DC Senior Housing Summit; ACP position on SDOH; Life experiences and income inequality; RISE SDOH benchmark survey; the impacts of closing Auto plants; Knowality; and recent eHI & WEDI and NASEM events.

Shannah’s Insights and Reflections

I’m continuing with my new approach from year end and just sharing my general thoughts versus perspective on the bulk of this month’s activities.  I’m repeating my challenge to disprove predictions of limited progress in 2020 by seeking 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:
    1. Can we stem the downturn on life expectancy?
    1. Can we increase percentage and length of active life for the aging population living in communities of choice?
    1. 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

We’ve been sustaining and evolving the healthcare payment and delivery model for well over 50 years let’s not expect miracles when we know what is needed takes time.

The Moss Clinic story about a homeless man’s challenges and turn around due to interim shelter should be a wakeup call for what types of care team hires can make the biggest impact in healthcare delivery, specifically social workers and nurse navigators. It might also suggest how the health system and the State should invest in these hires at safety net clinics.

I’ve flagged the Lyft grocery access program under non-healthcare driven interventions, because I love the focus on community-wide needs, independent of any specific care delivery or coverage program. Even with the best-intentioned health system or health plan, investment it is often driven by their patient/member population rather than the community at large. This unfortunately can result in neighbors and families in the exact same situations not having needed support due to their healthcare coverage and access, regardless of their ability to control those options. At best it yields duplicative initiatives that could more efficiently serve more people. Some health systems do not discriminate in this fashion and are focused on improving their nearby communities. I applaud them and encourage adopting this model.

Both the Supreme Court ruling to allow implementation of the public charge rule and the newly announced Medicaid block grant option should be carefully monitored to make sure we don’t undermine the existing safety net that provides needed social and community supports with some of the greatest impact on health.

I’m a believer in the National Care Corps, but I don’t think volunteering will plug the large and growing gap in needed social supports and services. I worry that the program is viewed as an alternative to more sustainable long-term services and supports. I believe our nation needs both!

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 or individual story

The medical director from Moss Free Clinic in Fredericksburg VA writes a story about his realization of the importance of living conditions. Striking is the significant impact hiring a case manager with expertise in serving “severely disadvantaged populations” and that the hire was enabled by a grant from a foundation. Here’s one example of the impact. 

“…a homeless man who couldn’t work because he had such bad cataracts. He couldn’t get his cataracts fixed because he couldn’t do the necessary pre-op prep in the tent that he lived in.

Moravitz (the case manager) was able to find him temporary accommodation in a shelter, so he got his cataracts fixed. He was then able to get a job, and because of that, was able to afford an apartment. A great story of rehabilitation.”

Community Initiatives

Community Care Corps RFP was released on January 15th. Pursuant to an ACL Cooperative agreement with Oasis Institute, Caregiver Action Network (CAN), N4A National Association of Area Agencies on Aging (N4A) and Altarum institute. The program goal is “to foster innovative models in which local volunteers assist family caregivers, older adults, or persons with disabilities with non-medical care in their own homes in order to maintain their independence.” Applications can be submitted between February 10th and April 3rd. Awards are anticipated by June 15th.  The services of these volunteer programs will be designed to address many unmet social needs affecting living conditions of older adults, people with disabilities and chronic conditions and the care givers that help both populations.

Background on community investments and initiatives outside of healthcare

Lyft’s grocery access program continues to expand throughout the US. It offers low cost rides to low income residents of communities that have limited transportation options and live in food desert areas.

A 2018 report from the Alliance for Strong Families and Communities called was brought to the attention of everyone at the eHI WEDI SDOH event discussed below. A National Imperative: Joining Forces to Strengthen Human Services in America. It analyzes the challenges and sustainability of community-based organizations and human services agencies. It was not a known body of research for most of the attendees at the event, including me.

Government Initiatives Federal and State (national initiatives)

Trump Administration announces states can volunteer to convert their programs to block grants. States would submit a waiver request that allowed them to accept a cap on spending in return for more flexibility to offer more and varied services, more risk and less oversight.

The Supreme Court decided to allow the public charge rule to be implemented as the case is being heard. Enforcement will start on February 24, 2020. This expands the inadmissibility rules for immigrants if they are likely to become a public charge, i.e., be dependent on safety net programs like SNAP and Medicaid.

Senate bill Social Determinants Accelerator Act of 2019 was introduced with bipartisan support to establish an interagency council that will improve services across Federal low-income support programs. Minimal funding of $20 million is authorized. If passed it has the potential to identify improved ways to leverage services and resources across programs and have states and local governments test new models.

A recent DC Senior Housing Summit discussed affordability in senior housing. A prior post from Candace Robinson and Amy Herr underscore the severity of this growing problem – “The United States has a shortage of more than 7.2 million affordable rental homes for extremely low-income renter households. The supply of affordable housing for low-income older adults is declining while demand is increasing, threatening the ability of our nation’s vulnerable seniors to successfully age in their communities.”. This blog also highlights some great innovative models in Michigan, DC, New Jersey, Vermont and Pennsylvania to help change this trajectory.

Health System and Community-based Services

The ACP published Envisioning a Better U.S. Health Care System for All: Reducing Barriers to Care and Addressing Social Determinants of Health.

This is one of three position papers from ACP in which the organization is recommending comprehensive healthcare reform. The papers underscore the importance of healthcare access for all and the elimination of disparities. Their third policy position and recommendation in this position paper speaks to social determinants.

“3. The American College of Physicians supports greater investment in the nation’s public health infrastructure, research, and public policy interventions to address the social determinants of health and other factors that have a negative impact on health.”

Research, Metrics & Technology

NPR, RWJF and Harvard School of Public Health published a report on Life Experiences and Income Inequality in the US. The report shows the significant difference between the experiences of the top 1% earners and the middle- and lower-income earners all of whom still believe the American Dream is possible.

RISE Association in partnership with a senior fellow from the Kennedy School of Government are conducting a benchmarking survey of SDOH initiatives. Organizations are encouraged to participate in the survey here.

Auto plant closures linked to rise in opioid deaths. “Five years after a plant closed, opioid overdose deaths for individuals ages 18 to 65 were 85 percent higher than predicted in counties that did not face an automotive assembly plant closure.”

Knowality a new venture services firm headed by the former Chief medical officer of the Blue Cross Blue Shield association, is focused on helping startups address SDOH.

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

I attended this event. With the exception of the final presenter, William Hazel MD, there was unanimous support for the continued growth and need for investment, analytics and solutions to address SDOH. There was also a broad set of approaches and varied definitions and beliefs on the what, why and how and who should pay. Given the host organizations’ perspectives, the emphasis was definitely on data. Hazel cautioned that this should not follow the path of “Meaningless Use” indicating the jury, from the care delivery side, on the benefit of EHRs and the burden of technology and data requirements is at best still out, and at worst, decided — there is little to no benefit.

The recent Webinar on the September NASEM report highlighted that they are holding regional meetings and seeking to move industry and communities forward.  Integrating social care into the delivery of health care: Moving upstream to improve the nation’s health. Washington, DC: The National Academies Press. They are conducting a survey about what organizations are doing to integrate social care and looking to get feedback and more involvement. Contact Robyn_L_Golden@rush.edu if you want to get involved.

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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