2nd Blog in This 3-Part Glass-is-Half-Full Series: The Path to Progress is Paved with Social Determinants

If you haven’t checked it out yet, the Robert Wood Johnson Foundation’s Leadership Network (in which I’m delighted to participate) is a consistently interesting and thought-provoking component of RWJF’s bold, expansive effort to create a Culture of Health in our country. I particularly liked one of the latest commentaries on this Linked-In site, which I urge you to read. It hits home for me partly because of its optimistic “we can do it” tone, which clearly comports with my own view of the future of health and human services in the U.S., but mainly because its headline resonates so strongly with the work that the Stewards of Change Institute has been doing: “Defining the measures of healthcare success.”

At SOCI, we long ago came to the conclusion that one reason greater progress hasn’t been made in this realm over the years – despite the exponential growth of new technologies and the ever-increasing understanding and implementation of principles like information-sharing and interoperability – is that vital elements have been missing from the equation. As I discussed in the first blog of this series, titled “Pessimists Beware,” those elements are the Social Determinants of Health and Well-Being (SDoH).

The very good news is that the Social Determinants are an integral part of the Culture of Health’s expansive vision and ambitious work and, of potentially huge significance looking forward, they are now officially part of the U.S. government’s own agenda for improving the lives of Americans. In short, just a few weeks after SOCI’s recent 10th National Symposium in (at which SDoH were at center stage), several federal agencies issued a “tri-agency letter in which they announced the extension of important components of the Affordable Care Act relating to interoperability – and, most pointedly – in which they explicitly pointed out the importance of SDoH in advancing “national health and wellness goals.”

In my view, as I indicated in my last blog, this could be a game-changer; now I’d like to elaborate with just a few examples of why I believe that’s the case:

o   The letter announced a three-year extension of the 90% federal match (FFP), so states can receive the financial resources they need to initiate, continue or extend building connections between Medicaid programs and social/human services programs. (The A87 cost allocation waiver was also reauthorized by OMB for this same three-year period).

o   The extension not only provides states with financial and administrative flexibility and resources, but also a sufficiently long runway to accomplish the type of technical linkage and integration that’s envisioned in the SDoH framework. (The initial 90/10 waiver had required all initiatives to be completed – not just be procured or be in-process – by the end of 2015.

o   The extension gives states the time to modernize Medicaid systems and, importantly, to design and link critical elements of their human service programs that serve the same people. This will be a tipping point that will allow the changes required to enable tens of millions of people to receive the coordinated care needed to accomplish holistic, person-centric care. This population includes many individuals and families for whom health and human services programs are vital because their complex needs require greater attention to the behavioral and environmental factors that significantly impact health – i.e., the SDoH!

o   Accomplishing better integration and interoperability is at the heart of improving the U.S. health and social care system and requires simultaneous pursuit of three aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health care. By enabling SDOH,we can make substantive progress in improving the lives of millions of people in the US and serve as a model for our partners abroad. 

The fuel for my optimism isn’t the letter alone, of course, though it’s obviously significant. Just as heartening are the “walking the talk” discussions I’ve been having with leaders of the Centers for Medicaid and Medicare Services, the Administration for Children and Families, and other decision-makers at the federal and state level. It has been increasingly clear during these conversations that they believe that SDoH should be and need to be integrated into ACA’s implementation, and that they are committed to providing the funding for building the types of holistic models and programs for which SOCI and others have been advocating.

That said, we also know that building infrastructure, installing “plumbing” and providing guidance is just the start of shaping change that will be genuine, pervasive and sustainable. So all the thought-leaders, educators, activists and other collaborators in this vital work have to simultaneously focus our efforts on constructing the organizational, legal, administrative and learning systems that support interoperability and that will enable our country to realize the potential benefits of SDoH.

Next up in Part III of this series of blogs: Why we need to expand the definition of interoperability to include a broader set of factors, so we can reach InterOptimability, as well as some more information about the curriculum in this realm that SOCI is creating with support from RWJ Foundation. Watching progress like this, and being a part of it, is absolutely energizing.





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