Health care disparities are often viewed through the lens of race/ethnicity and socioeconomic status, but they occur across multiple dimensions, including age, geography, language, gender, disability status, citizenship status, and sexual orientation. During a session at AMCP Nexus 2020 Virtual, Kim Ibarra, MBA, MSc, managing director of the National Quality Forum, discussed the role of health disparities and how to promote health equity.
Community-level conditions in the environment in which people live, learn, work, play, worship, and age impact health more than biology and health care and are the primary drivers of unavoidable, unjust differences in health outcomes. A person’s zip code may better predict health outcomes than their genetic code, according to 2014 research from the Harvard School of Public Health.
Examples of social determinants of health include food insecurity, housing instability, literacy and language, access to transportation, exposure to crime and violence, level of education, degree of social connectedness, and economic stability.
Up to 80% of health outcomes are driven by social determinants of health. This has been demonstrated by the fact that infant mortality is higher among those born to non-Hispanic Black women across all ages and socioeconomic statuses. The COVID-19 pandemic has highlighted and heightened these disparities, hitting Black communities harder in terms of infection rates and morality risk.
Federal initiatives have sought to address social determinants of health. The Accountable Health Communities Model tests screening, referral, and navigation to connect patients with services to address health-related social needs. Recent changes to Medicare Advantage provide health plans with increased flexibility to add benefits to address health-related social needs. Proposed bipartisan legislation has also aimed to support states and communities to improve health outcomes.
According to 2020 data from the Centers for Medicare & Medicaid Services, among 750,000 screenings in Accountable Health Communities, 33% reported at least one health-related social need, including food insecurity (67%), housing instability (47%), transportation needs (41%), utility needs (28%), and interpersonal violence/safety (5%).
At the state level, 40 states have incorporated social determinants of health-related activities in managed care contracts or Section 1115 waivers. The State Innovation Models Initiative provides funding and technical assistance to states to develop and test payment delivery reforms, and some state Medicaid programs support a focus on social determinants of health through Delivery System Reform Incentive Payment initiatives.
Demonstrating the value of addressing social determinants of health, however, can be challenging, but early research, tools, and case studies show promise. Unaddressed social determinants of health can increase the risk of chronic conditions, health care costs, avoidable health care utilization, and mortality risk.
Ms. Ibarra gave an example of a Humana program that partnered with pharmacists to screen for social determinants of health and refer local resources. This resulted in a $1,500 average reduction in medical spend per member and a $500 average increase in pharmacy spend per member due to greater medication adherence. In another example, WellCare referred 33,000 people to 106,000 community-based services and saw a 17% decrease in emergency department (ED) use, 25% decrease in ED spending, and 53% and 23% reductions in inpatient and outpatient spending, respectively.
Addressing upstream social determinants of health enables organizations to improve population health management, reduce ED visits, and decrease avoidable admissions and readmissions.
In conclusion, Ms. Ibarra said the following actions can be taken to advance health equity:
- Integrate social determinants of health data into clinical care.
- Break down silos to enable successful partnerships among diverse stakeholders, including payers, employers, policymakers, consumers, pharmacists, etc.
- Expand core non-clinical services such as transportation, housing, and food.
- Advance social determinants of health measurement.
- Change conversations and organizational culture.
Presentation: M7 The role of Health Disparities and Social Determinants of Health in Promoting Health and Health Equity. AMCP Nexus 2020 Virtual.