 |
|
Perspectives on a selected key
topic
September / October 2020 |
 s
SDoH funding and coordination by Health Plans, Health Systems,
Government and other institutions the most effective approach in
reducing racial disparities in healthcare in the short-term, or
should a different approach be given the highest priority?”
|
Barbara Otto
CEO
Smart Policy Works |
|
The biggest lesson from COVID-19 is that healthcare alone
cannot improve the health and wellbeing of communities of
color. In fact, Black workers face two of the most lethal
preexisting conditions for the coronavirus – racism and
economic inequality .
Social determinants of
health do not happen in a vacuum – they occur in the context
of individual and neighborhood resources and the opportunity
structures in communities where people of color live. The
biggest lessons from the dual crisis of a global pandemic
and systemic racial injustice is that we can’t improve
health and wellbeing of communities of color unless we also
pay attention to both social determinants of health and
social determinants of equity which are driving racial
disparities in healthcare. Social determinants of
equity involve looking at policies, practices,
norms and values in our medical care and public health
systems through a racial equity lens. It requires us to be
monitoring inequality in opportunities and making the
connection between social inequities to disparities in
health outcomes.
Health plans, health systems,
and other institutions have an important role to play in
eliminating barriers to SDoH and reducing healthcare
disparities. Yes, the healthcare sector has the financial
capital to make strategic investments in SDoH and related
care coordination tools, like online platforms. However,
focusing on SDoH alone will not reduce racial disparities in
healthcare. Social determinants of health occur in the
context of individual and neighborhood resources and the
opportunity structures in communities where people of color
live.
Change happens at the speed of trust,
and while individual health practitioners may have the trust
of their patients, the healthcare sector as a whole does
not. The financial capital the healthcare sector brings to
the table is critical, however, if we want to move the dial
on racial disparities in healthcare we need to leverage
social capital built over the years by the social services
sector. Unfortunately, some in the healthcare sector are
forging ahead alone, sometimes re-creating SDoH services
networks that at best serve just their members or patients,
and at worst, are duplicative.
Health plans,
health systems, and other institutions should view the
social sector as a force multiplier, “boots on the ground”
to help people navigate the health system and SDoH. We all
know our health system is complicated, and frankly,
complicated systems can discriminate against vulnerable
populations in effect, if not by intent. If the healthcare
sector is truly committed to value-based care, now is the
time to come to the table and make long-term investments in
social sector partners that are building and delivering
neighborhood resources, and creating new opportunity
structures for under-resourced communities. These
investments should be for general operating support and for
services like outreach and engagement and navigation
supports – services people need, but rarely reimbursed by
payers and never adequately funded by government and
philanthropic grants.
The pandemic has caused
economic downturns in nearly every state, which will likely
translate into cuts in government spending on SDoH and
community resources at the very time when we need it the
most. Now is the time for bold action. Is your health plan
or health system ready to move from talk to action?
|
Lindsay Resnick
EVP
Wunderman Thompson Health |
|
Payers, providers and other healthcare institutional
stakeholders are essential components of SDoH solutions. And
they are particularly effective when linked with community
‘influencer’ organizations that can provide local insights
and serve as public healthcare rallying point.
Families across the nation, urban and rural, are in crisis.
They are wrestling with an array of financial burdens to a
degree few ever experienced – unemployment, financial market
downturn, business closures, and strained household budgets.
People are being stressed-tested to the max. In the
short-term, uncertainty about the COVID19 shutdown timeline
and access to a safe, science validated vaccine is driving
consumer anxiety. Add to the mix healthcare costs, already
outpacing wages, with high deductible health plans and
climbing out-of- pocket expenses, consumers are facing
extraordinary financial health burdens. They are delaying
care, skipping prescriptions, and ignoring chronic
conditions.
Social determinants of health SDOH
are the circumstances in which people are born, grow up,
live & work, their behaviors, and systems put in place to
deal with healthcare. We know that socioeconomic disparities
in income, literacy, housing, jobs, nutrition and education
are forces that can have twice the impact on an individual’s
health than biology, DNA, and clinical care.
Health inequities are avoidable or unfair differences in
distribution of health resources between diverse population
groups. For example, life expectancy of a black Chicagoan is
nearly 10-years lower than their white counterparts. Babies
born 6 subway stops apart in New York City have a 9-year
difference in life expectancy. COVID19 has highlighted these
health inequities in terms of who gets tested, hospitalized
and treated. It has been glaring in communities of color.
There’s nothing like a pandemic to shine a bright light on
gaps and imbalances in our healthcare system. And
unfortunately, given the confluence of economic, political
and healthcare forces we’re likely to see things get worse
before they get better: increasing number of uninsured
Americans, strained state Medicaid budgets, an aging chronic
population, partisan gridlock stalling progress, and rampant
mental health issues associated with the pandemic and its
‘life disruptors’. So indeed, it is going to take every
healthcare stakeholders to ante-up and help solve
disparities and inequities in our neighborhoods. Investing
in epidemiological, data driven methodologies that support
integrated community based SDoH programs focused on
under-served populations will improve quality of life and
over time, life expectancy.
|
Pam Nicholson
Director
BDC Advisors |
|
As a former CSO of a large health system, I was committed to
the mission of improving the health of the communities we
served. To serve the community (whole person) meant
addressing the physical and mental health needs and
impacting the environment and socioeconomic factors through
shared programs, funding, and advocacy to address public
policy. Improved health happens when resources and services
are provided to areas of need, not necessarily when we ask
the community to come to our facilities.
There
are at least a dozen different Social Determinants of Health
(SDoH), which
impact disparities in health. These
include geography, income levels, educational opportunities,
employment, workplace conditions, access to health
insurance, gender inequity, social services, racial
discrimination, food insecurity, public safety, and
affordable housing and utilities. While medicine has made
fantastic progress over the past two centuries, many of our
public health challenges remain eerily similar to the
mid-19th century when British Social reformer Edwin Chadwick
published his findings documenting the disparities in health
and sanitary conditions among the more and less affluent
segments of British Society. According to the Institute for
Medicaid Innovation, socioeconomic and environmental factors
account for 50% of overall health outcomes; 30% are tied to
health behaviors. Quality healthcare services only make up
20% of health outcomes.
We can be successful in
addressing SDoH if the objectives are clear and measurable.
Starting with an understanding of the community (population
health and geography) and utilizing public data sources such
as demographic, public health, and economic data will
provide a path towards improvement. When we address racial
equity and the impact of COVID-19 on jobs, education, and
mental health, all parties need to understand the realities
and fears and raise awareness and develop solutions in
partnership with the community they are serving.
Some health systems have found that value-based contracting
for a population can be beneficial if it includes
coordination of care along the entire continuum. Also,
health systems have found that partnering with those who
provide additional resources is critical to success.
Value-based care has motivated numerous health systems and
health plans to make non-traditional investments in housing,
transportation, care at home, and community gardens
addressing the whole person, not just the physical. Real
impact takes true collaboration and coordination.
|
|
|
|
|
(c) 2020, MCOL, Inc. All Rights Reserved. No redistribution allowed.
|
|
