COVID-19 and the Biden administration jump-start policy focus on social determinants of health

While social and economic factors have always influenced public health, concrete policy actions to address these disparities on the federal level have been limited. But the COVID-19 pandemic – along with policy priorities of the Biden administration – are finally changing the status quo.
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Social Determinants of Health

On August 18, 2020, the US Department of Health and Human Services (HHS) released Healthy People 2030, a 10-year initiative that defines goals and objectives to improve the health and well-being of people in the US. Healthy People 2030 organized these objectives into five categories, one of which is Social Determinants of Health (SDOH). This category examines the economic and social factors that influence individual and group differences in health status and why they are critical to improving health and advancing health equity.

Yet SDOH has figured prominently in Healthy People recommendations for the last decade without any significant change in policy that drives healthcare delivery in the US. However, 2021 appears to be the year that health policy begins to incorporate SDOH factors in HIT interoperability requirements and payment program design.

SDOH front and center

The COVID-19 pandemic was a wake-up call. Those most likely to be hospitalized, suffer poor outcomes, or die from COVID-19 are individuals in racial and ethnic minority groups – particularly those experiencing inequities in social, economic, health, and environmental factors. But, disparities in health outcomes for these groups are not isolated to the impact of COVID-19. Increased incidences of maternal and infant mortality, chronic disease, and mental health diagnoses can be attributed to disparities in SDOH.

In July 2020, the Biden campaign announced policy recommendations to address SDOH by leveraging health IT data to identify populations in need of help, invest in community health programs to serve those populations, and focus on programs to tackle hunger and homelessness. These commitments are becoming evident in the administration’s current health policy initiatives.

From policy to action

Critical to this effort is a methodology to consistently identify, measure, and exchange SDOH data. Efforts to develop health IT standards for interoperability in healthcare and care delivery models that incorporate SDOH are emerging. In January of 2021, the Office of the National Coordinator for Health Information Technology (ONC) updated the Interoperability Standards Advisory (ISA) to identify interoperability needs, technical standards, and implementation specifications needed to support SDOH in health IT.

The United States Core Data for Interoperability (USCDI), a standard established as part of the ONC Cures Act Final Rule, has scheduled USCDI v2 for publication in October 2021. This update contains data classes, data elements, and recently developed terminology to capture assessments, goals, interventions, problems, health concerns, and outcomes information related to SDOH. This will facilitate the collection and exchange of standardized data on SDOH between caregivers and payers.

Acknowledging specific needs

Furthermore, on April 12, 2021, HHS announced the expansion of Medicaid benefits for women during the first postpartum year, noting that HHS will make $12 million available over four years for the Rural Maternity and Obstetrics Management Strategies (RMOMS) program.

Funding for RMOMS will focus on programs for populations that have historically suffered from poorer health outcomes, health disparities, and other inequities. And, on April 23, 2021, the Centers for Medicare & Medicaid Services (CMS) Innovation Center published a case study on Health Net of West Michigan’s success in developing collaborative solutions to identify and address SDOH factors in the Accountable Health Communities (ACH) Model for community services and clinical care. 

The Biden administration is clearly cognizant of the impact of SDOH on efforts to build a more equitable healthcare system. It will be exciting to see how SDOH factors are incorporated in established CMS payment programs to ensure equity in care delivery and improved patient outcomes.

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