May 2019 Newsletter


Welcome to the May 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: My recent blog on why asking for help shouldn’t be so hard; Fannie Mae’s innovation awards for improved housing; several stories about the substantial impacts of poor living conditions on healthcare in hospitals, FQHCs and primary care and the breadth of needed changes; More initiatives from Cerner and Kaiser and Blues plans investing in Solera Networks; a Health Affairs’ article on the need for further research; and many surveys from different vantage points.

Shannah’s Insights

First, apologies for being late with May’s newsletter. I’m contemplating bimonthly newsletters, at least through summer. In May, there is no question that investments in living conditions are needed and a growing trend. BUT (of course there is a but), many of this month’s activities underscore the question of scalability and are still heavily healthcare focused and driven. The Health Affairs article speaks to some of the outstanding questions. Fannie Mae’s sustainable communities’ awards are heavily leaning toward healthcare, when we need the pendulum swinging the other way.

The lack of community initiatives also may be an indicator of undue healthcare focus, although perhaps I’m not casting my scan broadly enough. I too have fallen into the trap of using social determinants of health as a filter. A quick broader scan however shows how efforts are siloed and self-defined, e.g., sustainable cities is an environmental lens. I will work on expanding my lens with equitable and livable communities in the next newsletter. These community initiatives often seem broadly focused on economic development that is pretty far removed from reaching individuals. I welcome your thoughts here.

The first three items under health systems emphasize how large an impact living conditions have on health and healthcare and how much has to change in terms of culture and focus to really make a difference. The focus of these stories relates to why I’m scratching my head about Avalere’s findings on dually eligible populations in MA plans. It should not be at all surprising that duals are more likely to have greater social needs due to their eligibility characteristics (low income and often disabled) that make it fundamentally difficult to afford viable living conditions that drive greater health utilization. The cycle of unmet needs and their impact on health is what has to be broken and not with more healthcare, hopefully they agree.

Education efforts and continued investment in links to community services are happening on a larger scale as evident by the remaining health system and community-based stories.

Surveys abound confirming the need for support of improved living conditions, but also highlight how best to capture, share and then act on information all have their challenges. The home care survey is of a slightly different ilk, indicating that the market believes the coverage under Medicare Advantage will increase the contracting and availability of home care services in 2020, particularly non-medical services.


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

I wrote a blog for my startup company Livpact Inc. about why asking for help should not be so hard. It all started with a friend who helps everyone saying she wasn’t comfortable asking for help with caregiving. Check out the blog. I think it should resonate with most adults whether it is about caregiving or where you may be stuck professionally. The relevance for living conditions is that it is hard to ask no matter what our personal circumstances look like.

My referencing the blog is also my first foray into integrating all of my professional hats. When I started the newsletter over a year ago I thought I needed to keep the newsletter separate to avoid bias, but my work informs the newsletter rather than creating bias. If you read anything that feels otherwise, please keep me honest!

Community Initiatives

No notable community initiatives this month.

Government Initiatives Federal and State (national initiatives)

Fannie Mae awards $10M to help address living conditions and health. 2 out of 5 awards arguably invest in the healthcare side of the equation – Children’s National Health System virtual home visits and a nonprofit affordable housing agency that will invest in telehealth. The remaining 3 invest in housing, food, nutrition and employment.

Avalere research presented at the ISPOR conference in May, highlights the growth in Medicare advantage (MA) enrollment and that dual beneficiaries, i.e., people eligible for Medicaid and Medicare, exhibit more incidence of poor SDoH.

Health System and Community-based Services

Michelle Byrne’s article on what really drives most hospitalizations…Living conditions. “When I think about the patients on our rounding list, I think about needs that are not really addressed in the hospital. They don’t need more labs, more nights in the unit, more imaging, more consults. They need access to affordable housing, a safe neighborhood to walk around in for exercise and a grocery store with fresh vegetables down the street. They need jobs that pay enough for them to work reasonable hours, be able to spend time reading with their children at night and still pay their bills. They need health insurance coverage, mental health and substance misuse treatment, public school improvements, and transportation.” The article starts off with a woman on dialysis who regularly ends up at the hospital largely because she cannot afford transportation to her dialysis appointments!

UC Davis partners with area FQHC’s and develops a program to help all area residents with health needs. The journey to get to improved care and relationships underscores the need for communication and culture change.

A doctor in Canada who prescribes money, not exactly, but he has instituted income security specialists, a lawyer and legal assistant and standardized health equity assessments.

Healthcare Association of NY state developed a primer for trustees of hospital and health systems on SDoH.

Cerner Launches a collaborative on Social determinants with 30 health systems.

Kaiser Thrive Local program partnering with UniteUS to equip all providers with tools to identify and address mental health integration and connecting to local services for housing, food and safety concerns.

Six Blues Plans invest in Solera Networks $42M round, to fund an expansion into community support in addition to chronic disease management. This investment builds on the previous partnership with the BCBS Institute.

Research, Metrics & Technology

Health Affairs article on the Three D’s of Healthcare – Determinants, Data and Delivery highlights how Health Services Research is increasingly focusing on tracking these trends and how to understand what’s working and what is scalable.

Leavitt Partners Physician survey on Social Determinants of Health -“The survey found that while the majority of physicians believe SDOH matter for their patients’ health, most physicians do not believe it is their responsibility address these SDOH.”

McKinsey & Company survey findings on Social determinants of health. Survey of 2,010 consumers found that those with higher utilization rates of inpatient or ER services were more likely to report unmet social needs. In addition, 85% of those reporting multiple unmet social needs were interested in offerings from insurers to meet these needs e.g. food, housing, transportation.

60 second survey to determine living conditions? The survey is easily administered and finds 60% of people visiting the ED or internal medicine department needed in help in at least one of the following areas in the last 30 days: “day care, domestic violence, education, employment, food, housing, legal services, safety, substance abuse, transportation, utilities or other such social need.”

eHI survey on health information exchange highlights difficulties with sharing SDoH data. “Overall, 52% of respondents experience difficulty in exchanging SDOH data.” The difficulties are attributed to a lack of standards and difficulty navigating legal aspects of information sharing.

BU research on variation in SDoH screening and implementation suggests approaches need to be tailors to clinic practices

Home Health Care News survey shows 90% of homecare providers anticipate contracting with MA plans up from 59% today.

Please share the newsletter and connect via LinkedIn or email with your reactions and input.


The National Summit on Social Determinants of Health hosted by RISE in Washington D.C. June 23-25

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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