November 2019 Newsletter


Welcome to my November 2019 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: Bernard Tyson; Detroit medical students caring for the homeless; Oversight for the $1.5B ANC Healthcare trust in NC; alternatives to provider centric community initiatives such as land trusts, collaborative networks and public health initiatives; the role of CHCs in disasters and prevention; CMS changes in Medicaid flexibility and delay in consumer access regulations; hospital system investments in communities; Aetna/CVS’ loneliness program; US life expectancy downturn; Neighborhood Atlas and Healthify’s latest investment round.

Shannah’s Insights

Sadly, Bernard Tyson’s passing is another loss to health equity and moving toward more wholistic care. He has been a critical force in Kaiser’s community-based innovations.

I’m excited about the range of alternative investment/development models that are less tethered to the care delivery systems and more focused on sustained community improvement. I’m particularly intrigued by the land trusts for expanded and affordable housing and the collaborative networks where the solution will be for the collective benefit of the community distinct from each provider or payer organizations priorities.

CMS’ clamp down on Medicaid at a time when there is acknowledged need for more flexibility even by CMS’ own statements is a mixed message at best and potentially will weaken states’ abilities to advance innovation. The apparent delay in finalizing the no blocking rule for Medicaid and Medicare managed care plans is likely driven by the continued resistance of providers and plans to patients and families having easier access and control over their own medical information. There are financial and accountability concerns, but the bottom line is that individuals who want, and are entitled to the data will suffer.

Community Health Centers are a critical component of community safety nets for public health, healthcare and emergency response. Nevertheless, their total funding in 2017 was $26.3B, ~0.75% of the total US healthcare expenditures. The Medical student initiative in Detroit could perhaps augment the efforts of CHCs and sounds as though it perhaps could groom more physicians for working in these critical delivery environments.

The announcement of the 14-hospital pledge of $700M has received substantial press. I applaud their investment, but also feel context is important. Barely a rounding error on the total 2017 healthcare expenditure. Kaiser alone generated $79.7 Billion with $2.5B net income in 2018. Meanwhile the Indiana University fund exceeds the investments of the combined pledge. The independent oversight of the ANC Healthcare $1.5B trust, the result of the HCA Mission merger underscores the potential and need for much more significant funding.

The CVS Papa collaboration is the latest example of increased focus on loneliness and Papa seems to be an approach of choice for health plans. Who wouldn’t want a stand in adult grandchild to visit and help every now and then?

The shortened US life expectancy should give us all pause. The JAMA article highlights that we don’t fully understand the underlying causes and that environmental and socioeconomic factors are likely at play. The life expectancy data is broken down by state and analyzed across a number of demographic characteristics. This is another resource for initial data that states and communities can use when thinking about interventions. The Neighborhood Atlas from NIA & NIMHD will provided more detailed and targeted community level data free, but the data was collected from 2011-2015 and some current validation is likely warranted.

Healthify’s successful funding round of $16M matches perhaps its primary competitor Aunt Bertha’s from earlier this year. Let’s hope the competition is good for communities and the people they serve.

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

Bernard Tyson CEO of Kaiser unexpectedly passed away at age 60. Not only was he an innovative healthcare leader, but he regularly practiced everything he preached. There are many articles about his life and accomplishments. Former CEO of Permanente Medical Group Dr. Robert Pearl, characterized him as “a tireless advocate for population health and for the elimination of health disparities”.

Community Initiatives

Detroit medical students from three different programs take to the streets to provide care to the homeless addressing basic medical needs, but as important connecting with people on a personal level. The program makes a big difference for the people they help and teaches the students about care for people beyond medical care.

ANC Healthcare, formerly Mission, and Dogwood Health Trust, the new not-for-profit organization formed using net proceeds from the $1.5 billion deal in which HCA acquired Mission hospitals announced they selected an independent monitor to oversee HCA compliance. The $1.5 is supposed to be invested in study and addressing social determinants of health in Western NC.

Asif Dhar MD, Deloitte’s Chief Informatics officer, highlighted the need to shift some of our focus towards creating healthy communities and away from treating sick individuals.  Dhar noted two examples at the Exponential Medicine Summit: Oklahoma City’s response to being America’s fattest city in 2007 and Geisinger’s Fresh Food Farmacy. Both initiatives entailed more fundamental changes to how the community supported and enabled change for their residents.

Background on community investments and initiatives outside of healthcare

Land trusts as an approach to affordable housing has grown, but perhaps not at the pace it should, given the limited availability of affordable housing. Land trusts take down the cost of housing through the purchase of the land by a nonprofit organization that retains the land title but sells the housing. Bon Secours Mercy Health Hospital system has recently adopted this approach as a means to improve needed housing options.

Government Initiatives Federal and State (national initiatives)

On November 18, CMS issued Medicaid Fiscal Accountability  proposed rules to move Medicaid toward value-based care and eliminate new grants and open ended waivers according to CMS Administrator’s speech to Medicaid Directors. The comment period on the proposed rule end on January 17th.

Health System and Community-based Services

Community health centers (CHCs) play an important role in natural disasters and every day. An article from Direct Relief highlights the intersection of living conditions and health in the context of natural disasters, but goes on to highlight how CHCs have always been focused on public health and preventive health care.

Indiana University Health invests another $100M in its Community Impact Investment Fund. They will invest annually in four main areas: healthy living, educational attainment, workforce development and local initiatives addressing poverty and improved neighborhoods. This funding is in addition to $711 million announced last year. Four initial funded programs received $4.37 million over 4 years.

Payer philanthropy verses collaborative networks as inspired by New York’s Delivery System Reform Incentive Payment Program – All Medicaid managed care organizations (MCOs), contribute to support communities’ social needs and the network of providers, community-based organizations and MCOs will determine what is best to do. Distinct from individual payer philanthropy models in some respect doing a one-off program for their members.

Aetna/CVS, announced collaboration with Papa Inc. to connect Medicare Advantage members suffering from loneliness with college-aged caregivers. The program will start in Florida where Papa first launched. Papa provides services in 15 states. Aetna is also rolling out a “Social Isolation Index” to identify members at risk.

Public health and healthcare systems working together in a multisector integrated approach is recommended by John Auerbach CEO of Trust For America’s Health. In a more in-depth publication, he highlights the need to leverage the expertise of the public health sector and its ability to focus on population health verses patient care otherwise the healthcare investment may be “…building a bridge to nowhere” as characterized in a clinician quote.

14 hospital systems from the Healthcare Anchor Network pledged $700M toward community based initiatives aimed at addressing economic and environmental drivers behind widening health disparities.

Research, Metrics & Technology

JAMA issues a special communication on the downturn in Life Expectancy and Mortality Rates in the US. The current US life expectancy is well below other developed wealthy countries. The underlying conditions include drug overdoses, alcoholic liver disease, suicides, and a broad range of health conditions. There is discussion of the underlying causes including socioeconomic conditions and the sustained health disparities among racial, ethnic and rural subpopulations.

National Institute on Aging and the National Institute on Minority Health and Health Disparities funded a new free tool to gather socioeconomic data about neighborhoods: the Neighborhood Atlas. Mapping and data come from American Community Survey data obtained from 2011 to 2015.

CMS’ interoperability rule that is a core component off eliminating information blocking for patients and families may be pushed out to 2022. The Unified Regulatory Agenda shifted the final implementation to long-term, to potentially give 3 more years to managed care plans under Medicare and Medicaid for compliance.   

Healthify raises $16M supporting networks of plans providers and social service organizations – collaborative referral platform

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


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