March 2019 Newsletter

Spring in my front yard

Announcement Module


Welcome to the March 2019 monthly newsletter. You can find past newsletters in my LinkedIn articles and on my website with some additional background materials, different stories and initiatives that might be of interest. Join me in improving and coordinating initiatives that advance health, health equity and community and healthcare redesign.

This month you can read about:

Living on $3 a day; The Healthiest U.S. Communities, Legal support at a public health clinic and Anthem Indiana Medicaid; The NSTC report on emerging technologies for an aging population; Oregon Medicaid’s approach to contracting for improvements in living conditions; the AZ Medicaid Innovation Challenge featuring many lead organizations in member engagement and technology and services support for improved living conditions; Molina Healthcare’s 90-day free Amazon prime accounts; PQA’s Conceptual framework on medication access; Several technology based partnerships — Kaiser and Community Solutions, BCBSI and Solera Health and Signify’s acquisition of TAVHealth; Research efforts from Tufts and Pew Charitable trust; and Femtech investments in unique health needs and living conditions of women.

Shannah’s Insights

Momentum of the health industries investment in living condition improvements continues, particularly in Medicaid and across large insurer and delivery systems. Are we using the right metrics? If we measure solely on health impacts, we may be missing an opportunity for true change. If Oregon is successful, could we ultimately invest more in community support that in healthcare?  Who will AZ choose as their partners for member engagement and improved living conditions. When looking at outcomes should we be looking across safety net programs and at quality of life?

Emphasis on close loop referrals is a growing mantra. We know it is important to know if a referral actually happens and if the person being referred actually engages. Many initiatives and organizations focused on minority and ethnic populations highlight the importance of trust, interest and willingness to engage. If we don’t invest enough in community supports could we risk increasing distrust?

I’m encouraged to see the range of investments and interventions along with the application of common technology in new ways e.g., Amazon Prime. As we continue to expand services and create new metrics, we need to remember the individual experiences and the subpopulations, including older adults, women, minorities and the poor, have unique living condition considerations that should shape the interventions and the metrics.

The Aging in America Annual Conference is less than two weeks away. Our panel on Healthy People 2030 will highlight a likely missed opportunity to advance healthy aging and contrast the National Science and Technology Council findings with the HP2030 direction.

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

A personal story

“Living on $3 a day and hope”, Holly Lawrence shares an inspirational story about the positive lessons of living in poverty. I applaud her courage and conviction but worry that she may be the exception versus the rule of how others in her circumstance survive let alone thrive.

My skepticism has me leading off with a raw quote followed by her 7 upbeat lessons.

“My poverty has accompanied depression and anxiety, often bringing me to the painful experience of being the “other” in social settings and relationships. Financial distress, and the way that society views the economically disadvantaged can take a brutal psychological toll, damaging your concept of self-worth and value.”

7 Lessons:

  1. Strive for quality friendships
  2. Remember nature belongs to us all
  3. You can find peace through spiritual fulfillment
  4. You can live just fine with few possessions
  5. Your voice matters
  6. Appreciate the power of creativity and resourcefulness
  7. The most important word for survival: Hope

Community Initiatives

U.S.  News and Aetna Foundation released 2019 Healthiest Communities Rankings, the top 10 counties come from 8 states with VA and CO having two counties in the listing. The report has an overall ranking of the top 500 Communities. States with unique overall trends are highlighted including, Colorado, Iowa, Utah and Nebraska the first two for overall top rankings the second two for leading a subcategory or metric, smoking rates and mental health respectively.

March/April issue of Annals of Family Medicine reports on a pilot about Embedding an immigration legal navigator in a primary care clinic.

“By embedding immigration navigation services within the primary care clinic, patients were able to secure supportive documentation, immigration representation, or both. Despite the high need identified in clinic, our navigator was sometimes unable to find adequate affordable immigration representation, particularly for asylum-seekers, even when maximizing community resources, which speaks to the need to bolster community legal resources.”

Government Initiatives Federal and State

The National Science and Technology Council released a report on Emerging Technologies to Support and Aging Population. The report concentrates on six areas in which technology can have a significant impact:

  • Activities of independent living
  • Cognition
  • Communication and social connectivity
  • Personal mobility
  • Transportation
  • Access to Healthcare

Oregon Medicaid’s latest contract cycle for managed care incorporates investment in Living conditions as part of performance standards.  

“Beginning CY 2020, CCOs (Care Coordination Organizations) will be required to spend a portion of end-of-year surplus, derived from annual net income or excess reserves, on Health Disparities and the social determinants of health…

Further, OHA intends to establish a two-year incentive arrangement… to offer bonus payments above and beyond the capitation rate to CCOs that meet SDOH-Health evidence-related performance milestones.”

The Arizona Medicaid Innovation Challenge event was live streamed on March 29th. Adaptation Health worked with the state and ran the innovation challenge. The successful applicants presented to Medicaid leadership in Arizona. The applicants were in one of two categories: member engagement or social determinants of health. The member engagement organizations were CareAngel, ConsejoSano, My Strength and PyxHealth. SDOH companies were Aunt Bertha, Equality Health in partnership with TAVHealth, Finity and Healthify.

Health System and Community-based Services

Anthem signs deal in Indiana to offer free legal services to Medicaid patients. Expanding the medical-legal partnership to support patients with services and access issues, particularly around housing, domestic violence and child support can create the more stable environment that supports better health outcomes and healthcare access.

Molina Healthcare in Washington state partners with Amazon to reduce barriers to healthy food and medical supplies delivery with free 90-day Amazon Prime accounts  that provide free delivery and subsequent discount rates.

The Pharmacy Quality Alliance (PQA) and the National Pharmaceutical Council brought together a roundtable on Access to Care for medication to develop a quality measure framework. The medication access barriers conceptual framework highlights cost, health literacy and transportation as cross cutting circumstances that underlie failure to get medications and stay on medications.

Research, Metrics & Technology

BlueCross Blue Shield Institute and Solera Health team up to address living conditions using a digital platform that will connect BCBS members to needed community services. The program started in three states and is expected to be available nationwide for BCBS plans in the second quarter of 2019.

“The platform, created by the integrated benefits network Solera Health, lists the different community resources available to patients in a certain region. BCBS beneficiaries will be able to “match” with different community care providers that meet various patient social needs.”

Kaiser partners with Community Solutions on Homelessness investing $3 million in their Built for Zero initiative that supports community leaders working to eliminate homelessness.

Signify Health Acquires TAVHealth

“Signify Health manages a nationwide network of 4,000 doctors and nurse practitioners delivering healthcare services in the home to over a million unique Medicare Advantage members each year. While in the home, Signify clinicians frequently identify SDOH needs…. The acquisition of TAVHealth adds a curated network of community-based organizations and the technology capabilities for Signify to directly manage these SDOH needs on behalf of its clients, creating a closed loop between identification of SDOH needs, enrollment into SDOH programs, and coordination of services to better manage and improve health outcomes for members.

Tuft’s researches model food insurance plans and predict cost effective savings and improved health outcomes.

Pew Charitable Trust Issue brief on Health Impact Assessments “Do Health Impact Assessments Promote Healthier Decision-Making?” highlights community stakeholder involvement can improve engagement, commitment and understanding across stakeholders in the community, enhance decision making, and “can contribute to more equitable access to health-promoting resources and protection from environmental risks.”

Forbes article on Femtech investments in digital solutions for unique health need of women underscores the distinct living conditions that affect females.

“…we need to move the dialogue and question beyond general social determinants of health to gender-specific social determinants. The list should include factors such as nutrition, impact of abuse (physical and mental), spending power, support system and solutions for working women, burden of elders and child rearing.”

Please share the newsletter and connect via LinkedIn or email 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.

2019 Health Summit: What Determines Health? May 30th hosted by Central Penn Business Group on Health and LiveWell health

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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