RISE looks at recent headlines concerning social determinants of health (SDoH).

Maternal death rates increase, disparities persist amid pandemic

The pandemic has taken a toll on maternal health, according to a recent analysis from the U.S. Government Accountability Office (GAO). The report, which used the most recent data from the Centers for Disease Control and Prevention (CDC), found maternal deaths have increased throughout the pandemic. Researchers also found the COVID-19 virus to be a contributing factor in one quarter of the maternal deaths in 2020 and 2021. Racial and ethnic disparities in maternal health persisted and intensified amid the pandemic as well. CDC data showed that:

  • The maternal death rate for Black or African American women was 44.0 per 100,000 in 2019 and increased to 55.3 in 2020 and 68.9 in 2021, whereas maternal death rates among white women was 17.9 in 2019, 19.1 in 2020, and 26.1 in 2021.
  • While the maternal death rate for Hispanic or Latina women was lower (12.6) than that of white women (17.9) in 2019, it increased significantly throughout the pandemic, reaching 18.2 in 2020 and 27.5 in 2021.
  • Preterm and low birthweight births also increased from 2020 to 2021, with a continued disproportionate impact on Black or African American women.

As part of its analysis, GAO interviewed relevant stakeholders and Department of Health and Human Services officials on maternal health amid the pandemic, who said the pandemic’s impact on SDoH, such as access to care, transportation, telehealth, housing, and employment, was a key driver behind maternal health disparities.

Racial inequities identified in heart failure treatment

Black adults receive less advanced heart failure treatment than white adults, according to a National Institutes of Health-supported study that followed 377 patients receiving heart failure treatments such as transplants and heart pumps.

Researchers found that 62 of the 277 white patients (22 percent) received a heart transplant or ventricular assist device, whereas 11 of 100 Black patients (11 percent) received the same life-changing therapies.

The findings stress the need to improve health equity, noted researchers. “The totality of the evidence suggests that we as heart failure providers are perpetuating current inequities,” said Thomas M. Cascino, M.D., the first study author and a clinical instructor in the Division of Cardiovascular Disease at the University of Michigan at Ann Arbor, in the study announcement. “However, recognizing disparities isn’t enough. As physicians and health care providers, we must find ways to create equitable change.” 

HHS approves Arizona initiative to address health-related social needs

The U.S. Department of Health & Human Services has approved a Medicaid section 1115 initiative targeting housing insecurity, a key health-related social need.

Arizona’s “Housing and Health Opportunities” program will aim to address housing insecurity by providing services to help people with stable housing, community and transitional housing, and rent and temporary housing up to six months after an individual transitions out of places such as congregate settings, homeless shelters, and the child welfare system. The program will also offer case management, outreach, and education services.

“Arizona joins a growing cadre of states that recognize a simple truth: health care can–and should–mean care for the whole person,” said CMS Administrator Chiquita Brooks-LaSure, in a statement. “We applaud Arizona for using every tool available to protect, expand, and test high-quality, comprehensive, whole-person models of care. We look forward to more states following your example.”

Staff, technology primary focus in transition to value-based care

Staff and technology are the top areas of investment among medical practices making the shift from a fee-for-service (FFS) model to value-based care, according to a joint report from Humana and the Medical Group Management Association (MGMA).

The report, Shifting to Value amid Pandemic and Staffing Challenges, builds on Humana and MGMA’s 2019 research study on personnel and technological strategies for a successful shift to a value-based care model. Using new data, the latest report sheds light on how primary care groups have worked toward value-based care amid both a pandemic and labor shortages.

Key findings include:

  • The total revenue from value-based arrangements was rather unchanged from 2019 to 2022
  • More than two-thirds (67 percent) of medical group leaders believe a value-based care model provides greater quality of care to patients than the FFS model, and 43 percent of practice leaders said value-based care was better for financial performance, compared to 31 percent who felt FFS was better
  • The primary investment areas among medical practices shifting toward value-based care are staff (74 percent) and technology (71 percent), followed by patient engagement (59 percent) and SDoH considerations (47 percent)
  • The most common staffing additions include care coordination (72 percent), care management (67 percent), data analytics (57 percent), and quality improvement (56 percent)
  • The leading forms of technology added by practices adopting value-based care include data analytics/reporting (82 percent) and population health management (57 percent)
  • Amid labor shortages, 40 percent of medical practices said they had physicians retire early or leave the practice due to burnout

HHS announces $15M in grants to address mental health crisis

The U.S. Department of Health & Human Services (HHS), through the Substance Abuse and Mental Health Services Administration (SAMHSA), announced this week it will award $15 million in grants early next year for states to address the country’s mental health crisis through Certified Community Behavioral Health Clinics (CCBHCs). The clinics provide 24/7 crisis services to those in need of mental health care or substance use, regardless of their ability to pay, place of residence, or age.

The $15 million in grants are an additional round of funding to the $300 million awarded to CCBHCs in September under the Bipartisan Safer Communities Act. The additional funding will be used to expand CCBHC planning grants to all 50 states, which are required in order to apply for a four-year demonstration program starting in 2024. The planning period is intended to allow states an opportunity to certify clinics, develop possible payment systems for Medicaid reimbursement, and prepare their applications.

“With these additional funds, we’re delivering on President Biden’s commitment to strengthen mental and behavioral health for all Americans, including people living in our nation’s most vulnerable communities,” said HHS Secretary Xavier Becerra, in a statement. “Behavioral health is health. Period. There should be no distinction. This investment will bring us closer to that reality.”