Developer and Community Perspectives

By EHRA Public Policy Leadership Workgroup

Health equity and social determinants of health (SDOH) currently play a large role in the national conversation on health care, with the Biden Administration ranking it as one of its highest priorities. Practically, however, these discussions have been underway for years.

SDOH and health equity are a public policy and care coordination challenge, one that health IT can play an important role in resolving. Consider that 80% of health is determined by non-clinical factors. However, there is a wide information gap separating healthcare organizations and the social and community agencies at the forefront of identifying and addressing these socioeconomic needs. Health IT and interoperability standards facilitate the secure, seamless exchange of patient data between these environments to improve population and individual patient health outcomes.

In September, the EHRA Public Policy Leadership Workgroup hosted a virtual Congressional Briefing to share insights around SDOH and health equity from multiple perspectives. In addition to discussing the current landscape, speakers highlighted activities underway to eliminate health disparities and offered recommendations on Congressional actions that could help the industry make further progress in this area. 

This blog summarizes the information shared during the virtual briefing. You can also review the presentation slides and listen to the full briefing (passcode: H@R$UZ02) in the “Positions and Statements” section of EHRA’s website. 

The Developer Perspective

According to Janet Campbell, Vice President R&D Relations with Epic and Vice Chair of the Public Policy Leadership Workgroup, data collected by healthcare organizations can reveal the extent to which care is being delivered to its intended recipients. Each category of data tells a different story – and presents a different challenge.

For example, electronic health records (EHRs) are already capable of capturing a wide array of SDOH, including race, ethnicity, and language, but this information is often missed because of inadequately trained staff or patients who are reluctant to share. A lack of standards guiding the collection of information, such as multi-racial or ethnic heritage, and the process of integrating emerging standards around gender identity or sexual orientation into workflows are also problematic. Consensus is also limited on what SDOH should be captured and how they can or should be used. 

Even when sufficient SDOH are captured to identify issues, matching the patient with needed services adds another layer of complexity. While some provider organizations have stepped up to establish in-house programs to manage high-risk patients, their ability to leverage existing technology to identify, enroll and monitor patients and program outcomes is something smaller community and social services programs do not share. For these organizations, sophisticated technology that enables the secure exchange of patient data and metrics tracking is simply out of financial reach – a situation that is not likely to change without help.

Thus, “one thing to consider when you’re thinking about how to smooth out social care in the community is how to make sure that technology is strong enough on all sides,” Campbell said.

As for how Congress can help, Campbell’s recommendations include:

• Supporting and funding community programs so they can purchase, implement, and use interoperable technology
• Supporting standards for SDOH exchange
• Working with HHS and others to clarify what data can be exchanged with community programs under HIPAA
• Reimbursing social care where it takes place, including coordinating activities by healthcare providers
• Studying successful social care programs built within provider organizations to serve their communities for lessons learned

However, she added, the most impactful action by Congress would be incentivizing consistent and complete data collection and then using that data to examine if disparities exist in current quality programs.

“Right now, CMS and other quality programs are already reporting on the quality of care delivered through those programs,” Campbell said. “It seems like a natural extension to take those quality measures that we’ve agreed upon and stratify them by race and ethnicity to understand the extent to which the programs are delivering that care and producing those outcomes in an equitable way.” 

The Community Perspective

Representing the voice of community-based organizations was Katie Adamson, Vice President, Health Partnerships & Policy, for YMCA of the United States. Through its 2,700 branches and state and regional alliances, the YMCA serves 22 million individuals, including 8 million kids. Its social reach and physical footprint – 80% of US households are within 10 miles of a YMCA facility – make the organization a powerful force capable of moving the needle on societal factors influencing health outcomes. 

According to the National Academy of Sciences and County Health Rankings, those factors are:

• Socio-economic (40%)
• Health behaviors (30%)
• Healthcare (20%)
• Physical environment (10%)

In addition to its status as a large employer, the YMCA leverages its substantial reach to implement community- and neighborhood-based programs targeting each factor. For example, the organization provides year-round opportunities for students that help close the achievement gap and is the largest childcare and after-school program provider in the country. And, in 2020 alone, it delivered 57 million meals to families in need. 

In terms of health behaviors, “we have worked to scale evidence-based programs that address diabetes, hypertension, arthritis, fall prevention, cancer and childhood obesity,” said Adamson, noting the YMCA is known for its diabetes prevention programs for which it gained Medicare coverage.

She continued: “We need our health systems to be integrated partners in improving health outcomes in the community. That’s why the Y has been working with public and private health payers to cover evidence-based health interventions and working with practices for referrals.”

Among those partnerships are initiatives with the CDC and Robert Wood Johnson Foundation designed to change community environments through multi-sector collaborations that range from building trails and bicycle lanes to coordinating safer school routes to getting grocery stores back into food deserts and building gardens at public schools.

Congress, said Adamson, can help by including lifestyle health, social connectedness, transportation, food and more under Medicare and Medicaid coverage, as well as existing partners in the community that provide these services.

“My top recommendations going forward would be [for Congress] to support funding for multisector social determinants of health partnerships at both the CDC and with Medicaid, which are part of the ‘accelerating social determinants of health’ bill that has been introduced into Congress…and to [ensure] that whatever technology is designed to refer to and pay for social services be available and accessible to community-based organizations,” she said, adding that this technology should “be designed with them in mind and with them at the table.”

Continued in Part 2