The Trump administration is thinking seriously about the role social determinants of health play in American healthcare and social services, said HHS Sec. Alex Azar at a join symposium between the Orrin G. Hatch Foundation and Intermountain Healthcare Wednesday.
“We are deeply interested in this question,” said Azar, “and thinking about how to improve health and human services through greater integration has been a priority throughout all of our work.”
Azar highlighted the Center for Medicare and Medicaid Innovation's 2017 Accountable Health Communities model as an example. Participating providers screen patients who use extreme amounts of healthcare services for factors of social and health insecurity and, if there’s a need, set up these medically and socially complex patients with navigators who can match them with community resources.
Evidence continues to mount that social determinants of health, such as having stable housing, access to food and economic stability, influence health outcomes, especially for low-income patient populations in vulnerable communities.
Zip code affects outcomes more than any other factor, which can “feel like a frustrating, almost fruitless situation for an American healthcare provider,” Azar said.
Currently, 31 organizations are participating in the $157 million Accountable Health Communities model scattered across the country, with the highest concentration on the East Coast.
Over five years, organizations screen for such social determinants of health metrics as transportation, housing and utility needs, along with food insecurity and risk of interpersonal violence.
The model then pinpoints high-risk beneficiaries and links them to community services in an attempt to address their health-related social needs.
CMMI also recently announced an accountable health communities model geared towards children, called the Integrated Care for Kids Model, focused on combating the opioid crisis from the nation’s youngest up.
A model like the Accountable Health Communities model takes advantage of "two key aspects of our decentralized, flexible system," namely, "the individual approach it enables and the incentives we can offer to private-sector service providers," Azar said.
Though the Accountable Health Communities Model is the first CMMI model to focus on the health-related social needs to Medicare and Medicaid beneficiaries, Azar hinted that the administration may take a more holistic approach to care quality moving forward. In practice, Azar said that might look like increasing organizations' flexibility to use federal funds to pay rent for a beneficiary's in unstable housing, or ensuring a diabetic has access to affordable, nutritious food.
Medicare Advantage plans are one avenue where CMS could tackle social determinants of care. In April, CMS gave the plans greater carte blanche in determining what supplemental benefits to offer beneficiaries, including meal delivery and transportation, to go into effect next year. Starting in 2020, that range of benefits will grow to include home modifications and more.
“Stay tuned” to what CMMI is up to, Azar said, but how exactly the administration will manage the complex societal implications of SDOH while prioritizing the “decentralized nature” of the American system, as Azar stressed Wednesday, is hard to say.