HHS Secretary Plans to Increase Role in Addressing Social Determinants of Health
November 16, 2018
There is mounting evidence that factors such as food insecurity, homelessness, violence, and lack of education can have a negative impact on long-term health and worsen chronic conditions such as diabetes and heart disease.
Health and Human Services (HHS) Secretary, Alex Azar, this week addressed the Hatch Foundation for Civility and Solutions, where he outlined how HHS will take a leadership role in addressing not just the health care needs of vulnerable populations, but also social determinants of health.
Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, and age that affect a wide range of health, and quality-of-life outcomes and risks. These determinants can include safe and affordable housing, access to healthy food, transportation, quality education and job training, and public safety.
In his speech, Secretary Azar previewed future value-based payment models from the Center for Medicare & Medicaid Innovation (CMMI) that could lead to financial support for housing and nutrition. Still in the early stages of planning, and code-named “Model One,” CMMI would pilot programs that would pay a single accountable care entity to cover both direct health care costs and improvements in addressing social determinants. For example, the entity could invest in housing or provide food vouchers to farmer’s markets. An ACO is a health care organization that ties payments for services to quality measurements and the cost of care.
This will not be the first time CMMI has targeted social determinants. Last year, they awarded funding to 31 organizations for the Accountable Health Communities model. Reading Hospital was the only Pennsylvania organization to receive this funding opportunity. Over a five-year period, the hospital will receive $4.5 million to coordinate medical care and social services for Medicare and Medicaid citizens of Berks County. They partnered with the Berks Community Health Center and community social service agencies to create the Berks Accountable Health Communities Consortium.
In addition, a number of Pennsylvania hospitals and health systems have developed or are developing innovative programs to address social determinants of health. The programs range from violence-prevention efforts and housing and transportation partnerships, to fresh food markets and job training.
Secretary Azar pointed out that “the root cause” of so much of health spending is social determinants of health. For example, the Agency for Health Research and Quality at HHS found that Americans with malnutrition are twice as costly to treat at the hospital as those who come in well-nourished. In fact, malnutrition is involved in 12 percent of non-maternal, non-neonatal hospital stays—$42 billion each year in health care spending.
Overall, the investments in social supports at the local level may lead to significant health care cost savings and improved standards of living. Successful programs would need to address local needs since urban residents may have very different challenges than those in rural areas. One plan would not fit all.
For questions about HAP’s efforts to work with member organizations in addressing social determinants of health, contact HAP’s vice president for population health, Rob Shipp, or senior vice president for clinical integration, Dr. Michael Consuelos.