July Newsletter

Summer Setting

Introduction

Welcome to the monthly newsletter. You can find past newsletter in my LinkedIn articles. 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: School meals; Immigrant inclusivity in Telluride CO, Healthy homes initiative in Eastern NC, The impacts of poverty, race and other social risks on Medicare Advantage quality ratings, Intermountain healthcare’s $12M investment in the Utah Health Alliance seeking to improve living conditions and health, The Dogwood Health Trust Foundation that could help western NC if the HCA and Mission Health System merger closes, and anticipated benefits and risks of using data about individuals’ social and behavioral characteristics.

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

A personal story

Imagine the child and family that is eligible for free and reduce school meals, embarrassed by the stigma of everyone knowing they are poor, but having made the choice to apply and participate to do what is best for their daughter. Then think about what happens when she is no longer eligible because the family just barely exceeded the eligibility limits. This is always a challenge for any income-based benefit with a cliff in eligibility. Putting away our policy lens and putting on a family lens are we putting this child in as bad or worse a situation because she is no longer able to eat in a way that helps her stay alert and engaged in school or because the family now has less money for their other daily needs if they shift the difference in income to pay for the meals for which they no longer qualify. Food insecurity is never good and the child who faces either a lack of food or the guilt of her family’s struggle will bear a burden she cannot control. Low-income communities can offer universal school meals regardless of income. Should the poor child who doesn’t live in the poorest communities be further penalized?

Community Initiatives

The Tri-County Health Network in Telluride CO is working on multiple fronts to foster inclusivity for its immigrant population to foster access to services and resources and to address the barriers caused by language. The Alliance for Inclusion and the Latino Advocacy Committee are two of the coalitions the Network engages to address barriers to inclusion. 30% of the Telluride population is Spanish speaking or of latinx decent, the majority are either from Mexico or Guatemala, where Spanish is not the primary language. The policies and actions of the current administration also make people afraid to seek services. Nevertheless Telluride has many innovative programs and encourages the immigrants to be more vocal and engage. Telluride’s immigrant challenges are a microcosm of what is happening in many other rural, urban and suburban areas, but perhaps with a more diverse immigrant population. Read more about their initiatives.

“The North Carolina Community Action Association has launched the Healthy Homes Initiative with the help of a $2 million investment by Blue Cross and Blue Shield of North Carolina.” Eastern North Carolina residents will be eligible for up to $2,500 in home repairs that could include: deep cleaning of home; interior pest control; air purifiers; interior access and fall prevention; and, carbon monoxide and smoke detectors. Eligibility will be based on income and other factors. All repairs are designed to improve living conditions and potentially lower utility costs.

Government Initiatives Federal and State

Study shows that Medicare Advantage plans’ star ratings suffer when they serve more low income, non-white and rural Americans. Research conducted by Brown University using Medicare data showed that if adjustments are made for race, poverty level and other social risk factors the quality measure for plans serving more members with these characteristic significantly improve. “If one thing is clear to them (the researchers), it’s that determining whether and how to adjust Medicare Advantage plan quality measures for sociodemographic factors is critically important to accuracy and equitable payment.”

Health System and Community-based Services

Intermountain Healthcare is leading the Utah Alliance for the Determinants of Health (the Alliance) a collaboration of city, county, state and other community based organizations dedicated to promote health, increase healthcare access and reduce healthcare costs by focusing on non-health factors that affect health outcomes. “Intermountain will be investing $12 million over three years—$2 million annually in both Ogden and St. George (Utah)—which will sustain the three-year demonstration project.” The project will focus on Selecthealth Medicaid members in four zipcode areas. The initiative uses the CMMI design on Accountable Health Communities and will use their screen tools to determine needed services. The goal of the demonstration project is to serve as a model for all of the US.

Dogwood Health Trust (DHT) foundation – “If and when the contemplated transaction with HCA Healthcare is completed, Mission Health System intends to convey the net proceeds of its sale to DHT following receipt of all necessary approvals and the development of required organizational infrastructure.” DHT will be dedicated to improved health and well being of the people and communities of Western NC.

Research, Metrics & Technology

“The Strategic Health Information Exchange Collaborative (SHIEC) has established a Social Determinants Committee, with the core aim to help SHIEC better focus on identifying and linking social determinants of health (SDOH) data and best practices between societal sectors across the country.” The Committee is intended to help advance collaboration and data exchange among the social services sector, community-based organizations and care delivery organizations.

Are social determinants of health and personal life style data or social media being gleaned to improve health or potentially used for a form of health profiling that will increase insurance rates? A recent NPR story highlights possible risks of this data being misused in setting insurance rates or cherry picking healthier people to insure.

Shannah’s Insights

Greetings from my summer vacation. I hope you all get a chance to relax.

The Telluride efforts on immigrant inclusivity are refreshing because of the expansive view of the many challenges facing its immigrant population. While the ENC effort is a more typical targeted program that may or may not help if it doesn’t look at the drivers of the housing problems.

The findings regarding Medicare advantage star ratings raises concerns about undermining the very programs that need to be supported and recognized for serving members that often have the greatest need. It borders on discrimination and is equally difficult to fix.

Intermountain’s investment is noteworthy because of its size. The combined zip code areas are relatively small with total population of <150,000. Select health is a wholly owned subsidiary of Intermountain so it is definitely in their interest, but the funding will invest in community services that serve a larger in need population.

DHT and the concept of revenue from mergers and acquisitions being used to improve health and living conditions in communities would be an awesome model to replicate given the sustained trend of care delivery consolidation.

In the world of research and data there is growing tension between the benefits of better understanding the living conditions and behaviors of individuals to improve health outcomes and the potential misuse of the data. This could undermine efforts to help individuals if people believe the information is being misused. It also could increase costs if privacy and security requirements extend to all organizations providing needed community services. Rather than clamping down on the access to information policy and enforcement should ideally focus on the misuse of the information. Let’s hope we can find a reasonable middle ground.

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.

UPCOMING EVENTS

The 2nd Annual Payer and Provider Summit on Social Determinants of Health for Complex Populations September 11-12, 2018 Washington, DC

3rd Annual National Summit on the Social Determinants of Heath, October 8-9th, 2018, Sheraton, New Orleans, Louisiana Root Cause Coalition

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