Aligning for Health is thrilled that the House Appropriations Committee has proposed significant funding and support for addressing Social Determinants of Health throughout its Fiscal Year 2022 Appropriations legislation. Today, the full Committee approved the Appropriations bill, which was previously approved by the Labor-HHS Subcommittee on July 12 and will now advance to the full House of Representatives for consideration. The Committee also released the FY22 Report, which includes more details on the funding amounts.
Notably, the Committee matched President Biden’s request of $153M for CDC’s Social Determinants of Health program; a portion of that funding will continue to go towards Social Determinants Accelerator Grants. The Committee also included instructions for HHS to continue to implement the Social Determinants Accelerator Council, as was included by reference in the FY21 Appropriations Report.
Below is the language included in the Report on the Accelerator Grants and the SDOH Council.
- CDC – Social Determinants of Health.—The Committee includes an increase of $150,000,000 for investments in social determinants of health (SDOH) to improve health equity. The Committee includes funding to expand activities to address SDOH in States, local, tribal and territorial jurisdictions to improve outcomes among persons experiencing health disparities and inequalities, including, but not limited to, expanding and implementing Accelerator Plans, initiating a SDOH implementation program, providing technical assistance to communities and continuing to build the evidence base and advance data collection to better understand health disparities. Social Determinants Accelerator Plans should include a description of the health and social outcome objectives; identify populations that would benefit from implementation of the plan, including Medicaid-eligible individuals; and identify non-governmental, private, or public health organizations and community organizations that would participate in the development of the plan. Grantees may use a portion of grant funding to convene government entities, public and private stakeholders, and to engage qualified research experts in developing Social Determinants Accelerator Plans.
- HHS – Social Determinants of Health Council.—The Committee directs the Social Determinants Council created by H. Rpt. 116–450 to continue to provide technical assistance to State, local, and tribal jurisdictions seeking to develop Social Determinants Accelerator Plans. The Committee directs a report be submitted, no later than 30 days after enactment of this Act, regarding the status of the selection of all Council members outlined in H. Rpt. 116–450.
Additionally, there were several other notable provisions related to social determinants, health equity, and maternal health. Highlights include:
- CMS – Social Determinants of Health.—The Committee is aware that social determinants of health are critical drivers of health outcomes and health care costs and that early childhood development is affected by social factors. The Committee commends CMS for the guidance on social determinants issued to States in January 2021 and encourages CMS to continue to clarify and disseminate strategies that States can implement under current Medicaid and CHIP authority, or through waivers, to address social determinants of health in the provision of health care, including strategies specifically targeting the pediatric population. This should include guidance on how States can encourage and incentivize managed care organizations to address social determinants of health through contracts.
- CMS – Evidence-Based Home Visiting Programs. — The Committee recognizes the wide range of improved outcomes and cost-savings that evidence-based home visiting programs provide to first-time mothers and their children. Additionally, in light of the impact of the COVID–19 pandemic on care and the rising rates of maternal and infant health disparities among families of color, the need for quality supports in the home is even greater, especially for mothers and babies. The Committee is pleased that CMS is assisting States that choose to design a Medicaid benefit package to provide home visiting services for pregnant and postpartum women, and for families with young children. The Committee urges CMS to continue to build upon its 2016 Joint Informational Bulletin to clearly articulate how Medicaid dollars can be blended and braided appropriately in home visiting programs to reach eligible families, provide streamlined coverage options for home visiting services, and cover specific components of home visiting programs.
- HHS Office of the Secretary – Data Collection to Measure Disparities.—The Committee recognizes that geographic place is a powerful predictor of social determinants of health. The Committee is concerned that due to residential segregation and subsequent disinvestment, the lack of access to health care, safe recreational facilities, quality education, and other resources, is often magnified in highly segregated communities. To fully assess population health, distribution of disease, and the extent of health disparities, health services data should be collected based on residency as opposed to where services are provided. A similar approach was taken to address the HIV/AIDS epidemic. The Committee recommends that all health services data include racial and ethnic data by subgroup, geographic indicators to the lowest levels (i.e., zip code tabulation area), nationality, sex, age, and primary language. This data should be collected in a standardized, uniform manner and include with it the capacity for linkages to various federal data sets. The Committee requests a report within 120 days of enactment of this Act describing the specific steps taken to ensure that geographic disparities were measured in COVID–19 data collection, documentation, and reporting from health care providers to public health agencies. The report shall also include recommendations to sustain data harmonization efforts to expand reporting for all infectious diseases and chronic health conditions and to address emergency prevention preparedness and response in the event of additional future pandemics and other catastrophes.
- HHS Office of the Secretary – National Center on Antiracism and Health Equity.—The Committee strongly supports efforts to advance health equity and reduce disparities for communities of color. The Committee supports the Office of Minority Health (OMH) and its efforts to advance health equity—however, the Committee believes the OMH currently lacks sufficient capacity to lead a broad and bold effort to address health disparities and that HHS should establish a National Center on Antiracism and Health Equity (Center) within the Department to lead efforts to identify and understand the policies and practices that have a disparate impact on the health and well-being of communities of color. The Committee directs the Secretary to submit a report, not later than 180 days after enactment of this Act, that provides detailed proposals to establish a National Center on Antiracism and Health Equity within the Department. The proposals shall include (1) a charter and goals for a National Center on Antiracism and Health Equity; (2) rationale for creating a new entity within the Department or restructuring an existing entity; (3) budgetary resources necessary to establish the Center; (4) the number of full-time equivalent employees needed to effectively carry out the Center’s mission; (5) the resources needed for the Center to establish, through grants or cooperative agreements, at least three regional centers of excellence, located in racial and ethnic minority communities; (6) the resources needed to award grants and cooperative agreements to eligible public and nonprofit private entities, including community-based organizations, to collaborate with underserved communities and for research and collection, analysis, and reporting of data on the public health impacts of health disparities; and (7) the resources needed for the Center to work with eligible public and nonprofit private entities, including community-based organizations, to provide information and education to the public on the public health impacts of health disparities and on health equity interventions, among other details.
- Assistant Secretary for Health – Health and Housing Initiatives.—The Committee is aware of promising initiatives developed by non-profit community groups in collaboration with local health systems and housing authorities that are targeted at homeless and precariously housed individuals who are high utilizers of medical care provided at hospital emergency departments. These programs work across different areas of core competency to provide safe, affordable housing together with ancillary medical, behavioral, substance use disorder, nutritional and employment or job training services. Participants demonstrate significant improvements in their health, sustainable incomes, and reduced use of emergency department and other expensive medical services. The Committee encourages the Department to support these types of initiatives through research, innovation models, health workforce and homeless programs, and other appropriate initiatives.
- HRSA – Alliance for Maternal Health Safety Bundles.—The Committee includes $14,300,000, an increase of $5,300,000 above the fiscal year 2021 enacted level and the same as the fiscal year 2022 budget request, to support continued implementation of the Alliance for Innovation on Maternal Health Program’s maternal safety bundles to all U.S. States, the District of Columbia, and U.S. territories, as well as tribal entities. Maternal safety bundles are a set of targeted and evidence-based best practices that, when implemented, improve patient outcomes and reduce maternal mortality and severe maternal morbidity
- SAMHSA – Projects for Assistance in Transition from Homelessness (PATH). – The Committee includes an increase of $10,000,000 for the PATH program, which supports grants to States and territories for assistance to individuals suffering from severe mental illness and/or substance use disorders and who are experiencing homelessness or at imminent risk of becoming homeless. Grants may be used for outreach, screening and diagnostic treatment services, rehabilitation services, community mental health services, alcohol or drug treatment services, training, case management services, supportive and supervisory services in residential settings, and a limited set of housing services.
- AHRQ – Research on Health Equity.—The Committee includes an increase of $3,000,000 for AHRQ to support investigator-initiated research grants related to health equity and an additional $1,000,000 to support research supplements related to health equity, the same as the fiscal year 2022 budget request.
A full list of provisions related to social determinants, health equity, and maternal health can be found here.
Aligning for Health Submits Statement for the Record for House Energy & Commerce Committee, Subcommittee on Health Hearing on SDOH
On Thursday, June 24, the House Energy & Commerce Committee, Subcommittee on Health held a legislative hearing entitled “Empowered by Data: Legislation to Advance Equity and Public Health.” Aligning for Health is thrilled that the Subcommittee convened this hearing to examine the importance of legislation to advance equity and public health.
We strongly support the Committee’s efforts to assess and discuss what actionable steps Congress can take now to improve access to, and the coordination of, public health, health care and social services. Improving data sharing and the delivery and coordination of care across public health, health care, and social service sectors will help to address upstream social factors, address unmet social needs, and improve health outcomes for all.
Aligning for Health submitted a statement for the record to the Committee outlining how social determinants impact health outcomes and drive health inequities, and the importance of cross-sector coordination and how bipartisan bills such as the Social Determinants Accelerator Act (H.R. 2503) can help address this. We also outline the importance of collecting, reporting, and exchange of health and social needs data, and how legislation such as the Leveraging Integrated Networks in Communities (LINC) to Address Social Needs Act (S. 509) would provide funding to states to catalyze, establish, and augment efforts to better connect and share information across sectors.
To read the full statement for the record, click here.
Aligning for Health is excited to announce the newest member of the coalition, Health Care Service Corporation. HCSC is the largest customer-owned health insurer in the United States and fourth largest overall, serving more than 16 million members across 5 states.
We are also delighted to welcome the National Association of Counties to our advisory board. NACo is the only national organization that represents county governments in the United States.
We look forward to working with both organizations as we continue to advance policy proposals that test the idea that the health and wellbeing of vulnerable populations can be improved by better aligning programs and services addressing the social determinants of health.
New coalition will emphasize role of social services. A new coalition is launching today to advocate for better integration of social service programs into the health care system in order to bolster outcomes. Aligning for Health’s initial membership includes the Blue Cross Blue Shield Association, Solera Health and WellCare. The group plans to highlight the role that factors such as access to nutritious food and safe housing play in health.
NEW HEALTH COALITION LAUNCHES TO ADVOCATE FOR PILOT PROGRAMS: A new coalition of health care groups launched today to advocate for pilot programs intended to improve health outcomes for Medicaid recipients by taking into account the effect of social factors on health care. Members of the Aligning for Health Coalition, run out of Sirona Strategies, are Alliance for Better Health, BlueCross Blue Shield Association, CareSource, Humana, Maxim Healthcare Services, Solera, UPMC Health Plan andWellCare Health Plans.
— Krista Drobac, chairwoman of Aligning for Health, told PI that by testing the effect of other social services on Medicaid recipients, the programs could improve health and save money for the program. “There is a lot of discussion about social determinants, but there are a lot of federal barriers to taking action in integrating social determinants, and so it became increasingly clear that we needed a policy effort in Washington to create the space for pilots to exist,” she added. Among the federal barriers, Drobac said, is the lack of inter-departmental funding that would allow for the coordination of a pilot program between the Department of Health and Human Services and another department with social-service programs, like the Department of Agriculture. The group is calling for temporary funding authority for pilot programs that would require inter-departmental coordination.
Health Payer Intelligence:
By Thomas Beaton
March 28, 2018 – A group of commercial payers and other healthcare organizations have formed a coalition to explore how addressing the social determinants of health can lower care costs and improve outcomes.
A number of large payer companies have joined the Aligning for Health (AFH) coalition, including the BlueCross BlueShield Association, CareSource, Humana, UPMC Health Plan, and WellCare.
AFH stakeholders cited research that suggests social factors including access to healthy food, safe housing, and financial security account for nearly 70 percent of all health outcomes. Addressing these social factors can have positive effects on healthcare outcomes, costs, and utilization, the coalition said.
“Every day, Americans find themselves without access to critical medical care, healthy foods and safe housing, which leads to significant health risks,” Kim Holland, Vice President of state affairs for BlueCross BlueShield Association said.
“That’s why we’re proud to work with Aligning for Health to enact real change that will improve the overall well-being and health of our citizens while ensuring the efficient use of resources.”
Rhonda Mims, Senior Vice President and Chief Public Affairs Officer at WellCare, said that her organization is committed to focusing on healthcare issues for high-need, high-cost chronic conditions.
Mims told HealthPayerIntelligence.com via email that WellCare can supplement their current community outreach activities and social innovation programs by joining the AFH.
“In 2017, we referred 33,000 people to 106,000 community based-programs and services,” Mims said. “A 2016 study by the Robert Wood Johnson Foundation’s National Coordinating Center for Public Health Systems and Services Research showed our model led to a 17 percent decrease in emergency department use, 26 percent reduction in emergency spending, a 53 percent decrease in inpatient spending, 23 percent decrease in outpatient spending.”
John Lovelace, President of Government Programs at UPMC Health Plan, added that working with AFH would allow his organization to enhance its current initiatives that address housing-related social determinants of health.
“We are excited about the opportunity to work with like-minded organizations to explore new options to better serve members through creative blending of funding sources,” Lovelace told HealthPayerIntelligence.com. “We all recognize that outcomes of health care are much more dependent on issues such as interpersonal supports, an affordable residence, sufficient food and safe communities.”
The coalition will promote holistic healthcare solutions through policy and outreach. AFH will work to extend opportunities to local communities that help address social factors related to health.
“Through a combination of research, direct advocacy, coalition building, and media outreach, AFH seeks to energize stakeholders and policymakers around the need to test the impact of greater integration at the local level, specifically whether it leads to more effective leveraging of federal poverty and healthcare programs to improve well-being and to lower cost of care,” AFH said.
“Our primary goal is to develop a consensus-based, bipartisan policy proposal that will allow communities to apply for demonstration programs that permit, with guardrails, the blending and braiding of funds to address social determinants of health.”