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Advancing Social Determinants of Health among Policymakers and Health System Leaders
June 2nd 2019
Adaeze Enekwechi, Ph.D., M.P.P.President, IMPAQ
AcademyHealth Annual Research Meeting
Agenda• Introduction: Social determinants of health:
Fundamental Cause Theory
• Shift from academia to delivery systems
• Challenges and opportunities in solving social determinants of health
• Recent progress among policymakers and health systems
• About IMPAQ
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What are Social Determinants of Health?
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Fundamental Cause Theory
Socioeconomic status and social supports are likely "fundamental causes" of disease that, because they embody access to important resources, affect multiple disease outcomes through multiple mechanisms, and consequently maintain an association with disease even when intervening mechanisms change.
Phelan, BG & Link, J. Social conditions as fundamental causes of disease. Journal of Health and Social Behavior, 1995
How Do Socially Determined Factors Affect Health Outcomes?
• Stress during life course
• Poor treatment and discrimination within the health care system
• Poverty (housing, transportation, low income)
• Poor nutrition
• Low health literacy
• Poor health habits (smoking, self medication)
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Growing Interest and Ability to Leverage Existing Tools and Resources
• The will to address Social Determinants of Health (SDoH) has grown recently, moving out of academia into health care and provider settings
• Addressing SDoH is increasingly recognized as the difference between fully responsive or inadequate health care systems
• Requires upfront investments, redirecting resources to targeted populations and needs
• And may require a slight reduction in the need to extract so much out of the health care system
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CHALLENGES OPPORTUNITIES
We don’t have the data systems to deal with these issues.We do. We have location, transportation, race/sex/age, and household data. We need to ask the right questions to integrate and use data.
How can clinicians be expected to deal with social factors? We can hire case/care managers and partner up with other non-clinical providers.
What is the business case for a hospital or physician practice group?
The business case is proven in the math, if we prevent a readmission, hospitalization, or institutional PAC use. We need to admit that business cases are not universal.
There are no tools with which to address social factors.Compassion. Understanding. Trained staff. Educated population and clinicians. Targeted resources. Patience. Perhaps we start with one or two manageable problems.
We don’t have any experience partnering with community based organizations.
We might need to tweak our process, share information, and equip them with additional tools to do what they do best.
We don’t know what people need. Ask them. Use valid instruments and keep them dynamic.
Moving Forward on Social Determinants of Health
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Recent Progress in Addressing Social Determinants of Health Among Policymakers• Approval of North Carolina Medicaid Managed Care 1115 waiver to pilot
enhanced case management (transportation, housing, toxic stress, violence, etc.)
• Cabinet level focus on social determinants of health
• Medicare Advantage allows bids to include non-medical needs (i.e., healthful food delivery, transportation for medical appointments, housing supports for safety)
• Recent signal by Secretary Azar to explore CMMI model that includes housing and other social determinants
• Need to update statutes that limit how Federal resources are spent
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Progress on Health Systems’ Efforts• Dedicated resources towards addressing SDoH, including funding, staff, and senior leadership
• Recognition of the role of anchor institutions
• Deciding which problems to solve (e.g., transportation, housing, food, childcare) can be fraught
• Tackling surface issues may not address difficult underlying social problems
• Realize this is a tough road:
• Integrated data needs to bring health, social, and geographic information together
• Senior leadership needs the will and ability to galvanize efforts and resources
• Conversations and training are needed for medical staff about unequal treatment and unconscious bias
• Meaningful runway (time) is needed to effect measurable change and improvements (we did not get here overnight so we won’t solve anything overnight)
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The Research-Policy Gap May Finally be Closing
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Research
• A century of evidence gathering has documented the strong link between mortality and disease and/or death
• A growing body of health care disparities research now has a focus on health equity
• There is also a growing body of research to understand the impact of alternative payment models
Policy
• Some health systems now address SDoH even if they won’t be immediately reimbursed for it (fundamental cause theory)
• Health care policy makers are beginning to think across silos (e.g. housing + health)
• Alternative payment and care delivery arrangements have driven providers and payers to consider non-medical needs to address costs and quality
About IMPAQ
ValuesIntellectual Excellence | Professional Integrity | Methodological Rigor | Diversity | Unparalleled Work Ethic | Entrepreneurialism
Technology & Data
Implementation, Training & Change Management
Policy Expertise, Research, Analytics,Quality Improvement & Innovation
Health Care | Education | Workforce Development | Social Programs | International Development
Founded in 2001
Approximately400 staff
~70% hold advanced degrees
Headquarters in Columbia, MD
Offices in Washington, DC; Oakland, CA; Boston, MA; Seattle, WA; and Neptune, NJ
Inc. 5000 Fastest Growing Company
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Health Insurance Access & Value Based Care
• Advanced analytics and reporting
• Operations and project management support
• Comprehensive technical assistance
• Policy & operational analysis, guidance, dissemination, and communications
Payment Models & Quality Measurement
• Implementing and monitoring new payment models
• Developing quality and performance measures, using new data sources
• Evaluating the success and sustainability of care delivery redesign and payment methods
• Evaluating cost and quality impacts of new care delivery and payment models
Quality Improvement & Innovation
• Identifying and assessing operational opportunities
• Driving change and improving care and outcomes
• Reducing hospital acquired conditions
• Innovation and integration of best practices
Pharmaceutical Health Services
• Understanding requirements for medication development, provision, and use
• Identifying, measuring, and comparing clinical and economic outcomes of drug therapy
• Developing measures and technical specifications for use in monitoring drug-related quality, performance, and outcomes
• Evaluating impacts of drug policy and drug-related educational needs of patients, caregivers, health care providers, and policy makers
IMPAQ’s Health Care Expertise
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Interaction
Why should the health care sector be responsible for addressing social determinants of health?
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Thank You
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Columbia, MD | Washington, DC | Oakland, CA | Seattle, WA | Boston, MA10420 Little Patuxent Parkway, Suite 300, Columbia, MD 21044 | (443) 259-5500 | [email protected] | @impaqint
www.impaqint.com
Policy Expertise, Research, Analytics, Quality Improvement, Innovation
Technology & Data
Implementation, Training, Change Management
Adaeze EnekwechiPresident
(202) [email protected]
