ISSUE #1: Efforts to Address Social Determinants of Health

The public and private sectors continue to focus resources and attention on tackling root causes of poor health.

The big picture: Policymakers, government agencies, non-profits, foundations, insurers, and health care providers are getting creative as they try to understand and improve social determinants of health (SDOH) – conditions like income, employment, education, housing, safety, transportation options, and others that shape how we live, work, play, learn, worship, and age. In the health care system, the push to address SDOH is growing as payers and providers navigate skyrocketing costs and growing evidence that non-clinical interventions may be the key to long-term health. Outside the health care system, organizations are looking for creative ways to collaborate and leverage resources to help all people get and stay healthy.

Social Determinants of Health (SDOH) – conditions like income, employment, education, housing, safety, transportation options, and others that shape how we live, work, play, learn, worship, and age.

On the horizon: As always, we’re watching our nation’s largest insurer, the federal government, for health care delivery and payment reforms that can help connect more people to food, housing, transportation, and other critical services. Medicare Advantage plans are now allowed to cover social services like home health aides and transportation and will begin doing so in 2019. State agencies are finding new ways to leverage Medicaid dollars. For example, in Louisiana the health department and housing authority are working together to tackle homelessness and reduce the institutionalization of people with disabilities, using Medicaid funds to support specific tenant services allowed under the law. Health insurance companies are also looking at ways SDOH can help rein in costs across the board, including in the private insurance market, as evidenced by Humana’s Our Bold Goal initiative. As we look for bright spots, we’re keeping in mind that the success of many of these ambitious policies and programs hinges on the engagement of community-based organizations and clinicians who need the capacity, technology, information, and resources to link complex systems and communicate over time.

In many communities, health foundations are continuing to shift how we think about “healthy” communities by focusing on issues that affect health, like race/ethnicity, zip code, and income. For example, the J. Marion Sims Foundation identified 11 “community indicators” to assess the health and wellness of the communities it serves in South Carolina, and has aligned its grantmaking efforts accordingly.  New York State has implemented several strategies related to SDOH, including requiring Medicaid managed care plans to cover at least one SDOH, prioritizing SDOH within the state’s Medicaid redesign, and creating a Bureau of Social Determinants of Health to ensure SDOH are considered and applied throughout the state’s health care delivery system. These innovative strategies are fairly new, so progress and outcomes are certainly something to monitor in the coming year and beyond.

In 2019, we expect as much or more attention on SDOH as public/private insurers, local and state government agencies, philanthropy, and community-based organizations across the country seek out-of-the-box solutions to complex, expensive social problems.