October 2019 Newsletter

Hopefully more treats than tricks!


Welcome to my October 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: Elijah Cummings; Michael Jordan’s investment in NC clinics; 50th anniversary of a White House Food, Nutrition and Health Conference; A Medicare executive order and open enrollment; More Medicaid programs embracing Lyft; NQF’s call to action; Foundational principals for healthcare initiatives in SDoH; Kaiser’s California food initiative; WellCare analysis of SDoH referrals; physician disagreement about focusing on social injustice; Technologies from, Urban institute; Sales Force, Aunt Bertha in partnership with Innovaccer and Socially Determined; eHI’s webinar about proposed ICD-10 Z code implications for improved living conditions; and, Patchwise Labs the Dispatch.

Shannah’s Insights

There was heavy emphasis on the importance of bi-partisanship in the early establishment of policy and programs to address basic human food and nutrition needs, at the conference, celebrating the 50th anniversary of the ONLY White House conference on food, nutrition and health. The discussions and participants were as focused on sustainable healthy food sources as they were on the health implications. The five principles for focused healthcare initiatives on social determinants, discussed in Health Affairs, may offer a needed bridge to foster sustainable solutions consistent with the conference findings and less emphasis on healthcare utilization. NQF’s call to action also could help bolster broader perspectives and a bigger tent for more stakeholders.

The uncertainty and ambiguity in the discussion of social determinants may be driving the provider debate about what role physicians and healthcare systems should play. The WellCare analysis of its social referrals is also a good example of what perhaps is a comfortable health system role. The question still remains how to promote investment in expanded community programs.

The loss of Elijah Cummings, a champion for social justice, will hopefully inspire others to fill his shoes. Michael Jordan’s help in funding clinics where there is inadequate access to care is heartening, but the question of whether this is the best investment for these communities lingers in my mind.

Medicare’s open enrollment and the coming year of coverage and services will set the stage for assessing how support for social needs, particularly in Medicare Advantage plans, impact health and healthcare utilization. Medicaid has supported social needs longer, for a higher need population, expansion with Lyft being one example. Medicaid should also be part of any future assessments. The Medicare Executive order may set priorities for Medicare regulation in the coming year and continue to foster innovation in Medicare Advantage, or may be the tip of the iceberg of politically motivated pronouncements.

Kaiser’s California food insecurity initiative is a great example of leveraging SNAP part of the existing safety net that is designed to help address food insecurity. It perhaps begs the question why this isn’t a standard practice for all health plans and part of the coordination requirements among safety net programs, most notably Medicaid and SNAP.

Last, but not least, is the continued growth in technologies and the call for improved data standards; this month’s entries lean toward analytics. Several of the tools are designed to improve community referrals. I recently heard the quote “It isn’t real if you can’t measure it”. It appears this is the mantra of the marketplace. I’m still concerned that metrics are being overemphasized in the early stages of implementation.

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 story

Elijah Cumming’s passing is a loss of a long-time champion of civil rights and the underserved and an example of health disparities. He never shied from a difficult battle as was the case after Freddie Gray’s death in Baltimore. Read more in this recent article from Leana Wen or watch the many eulogies that pay tribute to him and his legacy.

Community Initiatives

Michael Jordan helps fund two clinics in Charlotte NC for under and uninsured people without adequate access through his donation to Novant Health.

Background on community investments and initiatives outside of healthcare

A conference commemorating the 50th Anniversary of the first and only White House conference on food, nutrition and health. Recorded live streaming of the conference is available. A follow up event in DC occurred on October 30th. The emphasis was on food and nutrition as a critical need for improved health and welfare not tied to healthcare utilization. Some notable insights underscore the sustained poverty and disparities related to black and Hispanic populations noting 1-in-4 to 1-in-6 households struggle to afford food at least one month per year, more than twice as many among white non-hispanic household

Government Initiatives Federal and State (national initiatives)

Executive order on Protecting and Improving Medicare for our Nation’s Seniors. Is a distinct type of Executive order that is more like a regulatory agenda for CMS for the next year designed to be the Administration’s response to alternative healthcare coverage proposals.

Medicare open enrollment started on October 15th and goes until December 7th. Beneficiaries have more Medicare advantage plans to choose from most of them have taken advantage of the new flexibility to offer services that address social needs.

Five more State Medicaid programs sign up for Lyft non-emergency medical transport.

NQF call to action to align quality and payment innovation with addressing social determinants of health. Kicking it off with a congressional briefing. The recommendations were based on a Summit held in August.

Health System and Community-based Services

Health Affairs article When Talking about Social Determinants, Precision Matters, by Katie Green and Megan Zook establish five foundational principles to help successfully focus healthcare industry initiatives and appropriately partner with community services and infrastructure that already exist. Here’s a short hand of the principles:

  1. SDOH impact everyone and can be positive or negative
  2. SDOH and social needs are different
  3. Social risk factors and social needs also different
  4. Healthcare organizations are well positioned to identify factors and needs and help mitigate and address
  5. System level solutions need to move beyond silos

Kaiser California Food Insecurity initiative will text members who are eligible for CalFresh (California’s Supplemental Nutrition Assistance Program (SNAP) program) to encourage them to apply for benefits.

WellCare analysis of needs social support rises to the top. Based on 106,000 social service referrals the break down is described below.

“In the first half of 2019, the analysis found the top-requested referrals were made for family support services (20%), including prenatal and parenting education, child care, and child welfare-related services; followed by food access (16%); transportation (16%); utilities assistance (11%); medication assistance (7%); and housing (6%).”

Scientific American’s article highlighting disagreement on the role of physicians in social justice underscores the tension in what role healthcare should play and how to approach it. The debate was sparked by Stanley Goldfarb’s Wall St. Journal article saying medical students should not expand their focus to learning about social justice issues and population health.

Research, Metrics & Technology

Urban Institute has released a mapping tool for food insecurity along with additional tools and resources to help communities disrupt food insecurity.

eHI webinar on ICD10 Z codes and SDoH – presenters from Humana, AHA and United Healthcare talk about how standardized capture of Z code data can help address living conditions and social service needs. The discussion also highlights varied ability to act upon findings and needs given varied “treatments” and tracking of delivery.

Sales Force enters the field on social services connection with its Care Service Connect app for providers and case managers.

Aunt Bertha and Innovaccer partnership is designed to help with management of referrals for social services and resource needs. They are seeking to leverage their combined strengths of an extensive services directory with a social determinants of health solutions that establishes a vulnerability index for individuals to help refer them to services in real time.

Socially Determined startup raises $7.4 million. A data analytics firm “focused entirely on the science and measurement of the social determinants of health”.

If you want more insights about social innovation signup for Patchwise Labs the Dispatch. The November 1 edition discusses the nuanced differences of SDoH, social risk factors and social needs along with the growing anxiety of the health industry on its role.

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


Modern Healthcare Social determinants of Health Symposium December 3, 2019, Detroit MI

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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