Proposed Bipartisan Bill Targets Inefficiencies of Social Determinants of Health

July 30, 2019

A bill to include management of basic housing, food, and transportation needs – known as Social Determinants of Health (SDoH) – in high-need Medicaid patients was introduced on July 25. The bipartisan bill is titled the Social Determinants Accelerator Act. It would provide $25 million in funding for technical assistance and planning to better link disjointed services.

According to Cheri Bustos, one of the bipartisan sponsors of the Social Determinants Accelerator Act, the proposed Medicaid legislation, would address whole person care, non-medical factors that can improve health and well-being. It would allot $25 million for demonstration projects; no details were available on the funding source. Bustos specifically cited food insecurity, housing instability, and transportation reliability as areas of SDoH opportunity under the bill. The proposed legislation would:

1: Target a group of high-need Medicaid patients, like homeless individuals, older workers with arthritis, nursing home patients, or mothers diagnosed with post-partum depression;

2: Identify the key outcomes to be achieved through improved coordination of health and non-health services and use of evidence-based interventions; and

3: Include a plan for linking data across programs measuring the impact of the new approach on the health of participants and the return-on-investment for taxpayers.

In a 2016 Eccovia webinar, Dr. Adria Jackson, Executive Level Division Manager for the Houston Health Department, discussed how she and her staff integrated technology and data across multiple programs to better serve Medicaid patients through evidence-based, whole-person care. Among the steps to measure such a program’s success, she cited several vital steps. These include using technology and platforms to track a client’s progress and capturing the right data to report success metrics.

It turns out the Medicaid is uniquely adaptable to SDoH strategies, as 75 percent of enrollees are already in managed care plans. Yet states still have the flexibility to roll out solutions tailored to their specific needs

“There are opportunities for new technology,” Jeff Coughlin, Senior Director of Federal Affairs, Health Information Management Systems Society said. “I think this is giving money to states to spend on these different programs (such as) drug monitoring programs. Each state will look at this differently. The beauty of the Medicaid program is the autonomy for each state.”

The private sector is also taking an interest in delivering SDoH solutions for Medicaid providers. Tony Slavitt, a founding partner at Town Hall Ventures and former acting administrator at the Centers of Medicare and Medicaid (CMS), said that he is optimistic about CMS initiatives to better manage beneficiary care. He noted there are 120 million people in underserved populations (which would include those with chronic conditions) who represent $1.2 trillion in healthcare spending.

“This is the largest population in the country,” Slavitt said. “These are people with common medical conditions. We’re delivering subpar health outcomes (and) we’re doing it at a higher cost…”

To lower cost, he added, providers must tackle chronic conditions. For example, he said an excellent strategy to manage diabetes is to teach healthier eating. But for many Medicaid patients, SDoH barriers include a lack of convenient access to healthy food and transportation.

Addressing SDoH is not a new idea. SDoH was widely adopted as a hospital strategy to reduce readmission rates in at-risk Medicare patients by attending to “whole person care” under the tenants of the 2012 Affordable Care Act (ACA). For example, since the enactment of the ACA health systems have saved avoided loss of compensation and improved medical outcomes by cultivating SDoH solutions. This includes Montefiore in New York that invested in housing for its most vulnerable population and Geisinger, which provides a week’s worth of food for discharged patients.

There will be details to work out in the proposed bipartisan bill, ranging from data exchange to whether if states that have not expanded Medicaid coverage would be eligible to participate. But the response from the health and hospital to the proposed Social Determinants Accelerator Act has been positive.

“The Social Determinants Accelerator Act would better align resources to improve outcomes within the Medicaid program by funding planning grants for public and private sector accelerator programs, and convening an inter-agency technical advisory council on social determinants of health,” said Tom Nickels, executive vice president at AHA. “Hospitals and health systems recognize that addressing social determinants of health is central to driving value and advancing overall well-being…”