RISE looks at recent headlines concerning social determinants of health (SDoH).
HRSA updates ACA health care guidelines to improve care for women and children
The U.S. Department of Health & Human Services (HHS) announced this week the Health Resources and Services Administration (HRSA) updated the Affordable Care Act (ACA) health care guidelines to improve care for women, infants, children, and adolescents. Under the ACA, select group health plans and insurance issuers must provide coverage with no out-of-pocket cost for preventive care within the guidelines.
The ACA has increased access to preventive care with no cost-sharing, including services such as vaccinations, contraception, and cancer screenings, to more than 150 million people with private insurance, including 58 million women and 37 million children, according to a new report from the Office of the Assistant Secretary for Planning and Evaluation released alongside the announcement.
“Access to preventive care can help save countless lives and should be available without out-of-pocket costs, especially now during the COVID-19 pandemic,” said HHS Secretary Xavier Becerra in a statement. “These updated guidelines help ensure that we’re providing critical services to keep families healthy, based on the latest science and data available. The Biden-Harris Administration will continue to build on the Affordable Care Act to make preventive care available to as many Americans as possible nationwide.”
The updated guidelines address services including:
- Coverage without cost-sharing for double electric breast pumps
- Well-woman preventive care visits, access and counseling regarding contraceptives, and health screenings
- Obesity prevention counseling for women ages 40 to 60
- Universal screening for suicide risk for individuals ages 12 to 21, as well as new guidance for behavioral, social, and emotional screening
- Risk assessments for cardiac arrest or death for individuals ages 11 to 21
- Risk assessments for hepatitis B virus infection in newborns and individuals up to 21 years old
National Alliance makes recommendations for employers to address social needs among workforces
The National Alliance of Healthcare Purchaser Coalitions has released several recommendations for health care systems to address SDoH, such as economic instability, housing, transportation, and access to health care, to improve the health and wellbeing of employees and their families.
The recommendations come after a yearlong learning collaborative between the National Alliance, the Centers for Disease Control and Prevention’s Office of the Associate Director for Policy and Strategy, and the National Network of Public Health Institutes.
The National Alliance recommends employers:
- Gather data to identify social needs, social risk factors, population health challenges, and inequities throughout the community
- Further assess using various sources of data and engage public and/or private community organizations to prioritize actions with the strongest impact
- Collaborate with health plans and other vendors to develop a work plan and partner with community organizations that can identify SDoH and inequities by location and demographic groups
- Integrate health equity into organizational approaches and monitor progress and outcomes to determine areas for improvement
"Given the far-reaching impact to performance, morale and cost of care, this project found that employers were interested in their employees' social determinants of health," said Christa-Marie Singleton, M.D., MPH, chief medical officer, Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, in the announcement. "Organizations may want to consider that many of their employees may be facing issues such as homelessness and food insecurities. When employers can address the pressing conditions in their communities, it not only benefits the broader population, but also ensures that they have a healthier and more productive workforce."
Study finds Black women in U.S. at greater risk of preeclampsia than Black immigrants
Black women born in the U.S. have higher rates of preeclampsia than Black women who immigrated to the country, according to research from John Hopkins Medicine. The study suggests SDoH play a significant role in furthering Black maternal health disparities.
According to the study, which examined medical records for a racially diverse group of more than 6,000 women who delivered at Boston Medical Center between 1998 and 2016, white, Black, and Hispanic women born in the U.S. had greater cardiovascular risk than those born outside the country.
Additional findings include:
- Black women born in the U.S. had higher rates of preeclampsia (12.4 percent) compared to Hispanic (8.2 percent) and white (7.1 percent) women
- Black women born outside of the U.S. or with less than 10 years of residence in the U.S. had 26 percent lower odds of preeclampsia
- Black immigrants who lived in the U.S. for less than 10 years had a lower risk of preeclampsia (8.1 percent) than those who lived in the U.S. for more than 10 years (8.8 percent)
“Some women come here healthier and they get unhealthier over time probably by adopting habits of the dominant culture that increase poor health outcomes,” said lead researcher Garima Sharma, director of cardio-obstetrics, Johns Hopkins University School of Medicine, in a press release. “While we didn’t specifically look at the impact of structural racism on health in this study, it may also play a role here. Black women who were born outside the U.S. but immigrated to the country recently may be somewhat protected from the effects of discrimination because they tend to settle in immigrant-concentrated residential areas with increased social support.”
Survey identifies ‘disconnect’ between U.S. health systems’ DEI goals and implementation of objectives
WittKieffer, in partnership with The Health Management Academy, released a survey report evaluating the diversity, equity, and inclusion (DEI) goals of U.S. health systems’ governance boards and the operationalization of such objectives. A key finding from the Governance & Executive Leadership Trends Across Leading Health Systems report: While most health systems are committed to DEI goals, the actual progress is slow.
“Health disparities and inequities that have existed for years, and have been further amplified by the COVID-19 pandemic, have put additional pressures on health care boards to improve their governance practices,” said WittKieffer President and CEO Andrew Chastain in a statement. “This report should be a reminder for most, and a wake-up call for some, that it is necessary to be proactive and innovative in order to achieve strategic diversity, equity and inclusion goals from a governance perspective. This includes finding the right board members who can make change happen in a health system.”
Here are three key takeaways from the report:
- Boards have a heightened focus on recruiting board members with new strategy expertise who represent the communities they serve; however, health equity expertise is still underrepresented. Indeed, while 78 percent of Leading Health Systems (LHS) have a system-wide health equity strategy, only 3 percent of boards have members with health equity expertise.
- Because boards continue to rely on outdated personal networks to recruit new members, many are struggling to build a robust and diverse candidate pool.
- As boards look at modernizing their structures to further their progress, updating areas such as governance policies, onboarding and inclusion practices, educational services, board communication, and performance evaluations benefit the advancement of DEI goals.