Federal Recommendations to Address Social Determinants and Advance Health Equity

The COVID-19 pandemic exposed glaring gaps in our public health infrastructure as compounding health and economic crises overwhelmed our health and human service system.

That fragmented system – if you can call it a system – was no match for the havoc the virus unleashed. As a result, our response and recovery efforts were inefficient and disjointed. Federal relief dollars addressed many of the problems, but as needs for services related to food, housing, employment, and behavioral health skyrocketed, it became increasingly obvious that siloed programs focusing on one individual need at a time were missing a real opportunity – the opportunity to coordinate.

As a result, a diverse set of stakeholders including government, health systems, health plans, and community-based organizations are shifting mindsets about how to improve people’s health and well-being. It’s clear that if we break down silos between health and social care, and work collaboratively across sectors, we can move towards ensuring that everyone is connected to the services they need. As the Biden-Harris administration prepares to assume office in the midst of this crisis, we urge decisive action to create a more efficient and accountable system of health and human services centered on meeting individuals’ and families’ basic needs and addressing pervasive health inequities.

Invest in Social Care Infrastructure

First, the administration should increase funding and incentives to invest in Social Determinants of Health (SDoH) infrastructure. We need significant investment to understand and address SDoH and ensure that communities around the country are equipped with supportive infrastructure to facilitate wraparound care. A platform for service coordination not only provides critical information on the outcome of referrals, but also empowers providers to track a client’s longitudinal journey and gain insights into opportunities to improve those outcomes. State and local governments, faced with sharp deficits, cannot do this alone. The new administration has an opportunity to expand state and local aid, support direct investments in SDoH infrastructure, and use regulatory levers to make it easier for states to invest in coordinated care networks.

Comprehensively Assess and Address Social Needs

We must also ensure that everyone has the opportunity to thrive. That starts with asking the right questions and proactively identifying individuals’ needs. Screening for social needs should be required. All government-funded health and human service programs should receive enhanced funding to ensure screening for social needs. Rules and regulations governing social service interventions should be modified to encourage health plans and health systems to address social needs. While CMS has created more flexibility over the years, flexibility alone may not be enough to catalyze change at the widespread scale needed. Reforms such as the following should be strongly encouraged and incentivized, if not required:

• More permissive rules around the calculation of medical loss ratios to include effective social service interventions
• Further encouragement of “in lieu of services” and supplemental benefits in the Medicaid and Medicare programs
• Expansion of quality measures related to SDoH
• Consideration of social risk adjustment

Subtle changes can have transformative impact, and clear guidance can show the way for health leaders interested in addressing health-related social needs.

Advance Health Equity

Perhaps most importantly, the next administration must make health equity a top priority. Addressing social needs at the individual level is necessary, but it won’t solve the whole problem. To close the gaps in health disparities, it’s essential to shift investments upstream and meet individuals where they live – in communities. While it’s certainly difficult to find a silver lining in the midst of a pandemic, it’s encouraging to hear the widespread commitments from government, healthcare, philanthropic, and business leaders to understand and prioritize disparities experienced by people of color, and take concrete steps to advance health equity.

Effective strategies must begin with a strong foundation. We believe that social care infrastructure will lay the groundwork for more equitable and healthier communities. When health systems and community organizations work together in a shared, coordinated care network, it becomes possible to gather data and insights on gaps in resources and analyze the relationship between those gaps and outcome disparities. We must collectively target investments and policy initiatives to maximize impact and address the areas of greatest need. We must implement the right tools and build the infrastructure to translate sincere commitments into concrete results for those who have been underserved and marginalized for generations.

We urge the Biden-Harris administration to take advantage of lessons learned from the pandemic and invest in public health infrastructure that truly reflects the needs of communities. Our partners across the country are working to implement Unite Us infrastructure as a line of defense, to accelerate recovery, and to mitigate the impact of future emergencies. Now is the time to forge partnerships between health and social care, create a system to ensure that individuals’ needs are met, and equip communities with the resources they need to achieve health equity.

Eric J. Beane, Vice President of Regulatory and Government Affairs, Unite Us. Most recently, Eric served as Secretary of Health & Human Services in Rhode Island where he prioritized improving access to health care, controlling costs, and addressing the addiction and overdose crisis. He previously served as Chief Operating Officer for the State of Rhode Island and as Deputy Chief of Staff for the Governor of Maryland.

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For more on these topics, please watch Andy Slavitt, former Acting Administrator for the Centers for Medicare & Medicaid Services (CMS) under President Obama, and Dr. Zeke Emanuel, Vice Provost for Global Initiatives, University of Pennsylvania discuss policy opportunities with our CEO and co-founder Dan Brillman in SDoH and the Future of Health: Recommendations for the Next Administration.

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