On August 10, the Cambia Grove kicked off a series focused on social determinants of health with a panel of distinguished actors representing the health care community sectors currently engaged in this work.
During three separate events in August and September of 2016, the series provided a point of entry for health care organizations that want to address social determinants of health more systematically. One of the goals of the series was to establish a rich seed bed for collaboration on the interventions necessary to move this work forward.
While a growing number of organizations are focused on the impact of social determinants on the health of the diverse populations, the series was seen as an opportunity to provide more visibility and awareness for the topic of health disparities based on social and socioeconomic factors in our region.
Edited highlights from the event are available here:
Panelists on August 10 included:
· Mary Kay O’Neill, MD, MBA – Partner, Mercer (Moderator)
· Bob Crittenden, MD, MPH – Special Assistant for Health Reform, Office of Governor Jay Inslee
· Michael Erikson, MSW – CEO, Neighborcare Health
· Rashmi K. Sharma, MD, MHS – Assistant Professor of Medicine, Division of General Internal Medicine, University of Washington Department of Medicine
· Danette York, MPH, CPH – Director, Lewis County Public Health & Social Services
Dr. O’Neill opened the event with a brief description of social determinants of health–the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. She introduced the framework using the following graphic from the Healthy People 2020 Project, run by the U.S. Surgeon General:
She walked through each of the circles in the graphic, touching on how economic status correlates to health status, disease burden and longevity. Poverty, employment, food security, and housing stability were all identified as factors. Education included factors related to Early Childhood Education, high school graduation rates, enrollment in higher education, and language as well as literacy skills. Social and community context factors identified included discrimination, incarceration, civic participation and social cohesion. Key neighborhood and built environment factors were identified as quality housing, walkability, environmental conditions, crime and violence in a community, and access to healthy food.
Panelist Foci on Social Determinants
Dr. Bob Crittenden set the tone for the discussion. “Health care is great, I’ve enjoyed it, but after 40 years of it, it’s clear it’s not enough, we really have to intercede upstream a little bit.
“There are a lot of policies out there, but implementing them is hard to do. We’re in the process of doing but we have to do it well.
“One of the challenges is that we need an ROI. […] Everything we do has to have an ROI of about five years, otherwise it probably won’t be sustainable over time. To do that though, we have to really integrate how we finance things,” he said. The role of finance—and particularly the efforts to recapture and reallocate dollars in segregated revenue streams in order to maximize impact—was raised later during audience questions as well.
While discussing other ways efforts are moved upstream, Danette York explained that her agency—combining social services with public health over a primarily rural seven-county region—is constantly looking for housing for their indigent population.
“We are increasing [graduation rates] the past few years, and we’re excited about that.
“We’re also looking at trying to bring in higher education other than four year colleges or even two year colleges […] so that [students that are not going into higher education] can make a living wage.
“We do this on a daily basis, it’s very, very difficult,” she said.
Dr. Sharma is a palliative care physician and health services researcher who talked about the role of research. “We need more data still,” she said, “thinking about one: what is driving the differences we see—how do things like race, ethnicity, gender, education level, and access to health care translate into differences in clinical outcomes. The other piece is how we evaluate interventions to improve and address those issues. In the end of the day we are trying to improve the quality of care.
“That’s the role of research—to give us more data so that we can develop interventions to address issues, and then evaluate those interventions to make sure that we’re funding measures that will make a difference at the patient and eventually community level,” she explained.
Michael Erikson shared a couple of stories that illustrate the points of impact of Neighborcare, which serves a community of 62,000 patients—75 percent of whom are at 200 percent of the federal poverty level or less. He estimated that their goal of reducing the barriers to access–by going to schools or housing centers—would require them to be able to serve a population nearly triple that size.
“We’re on the front line of responding to the determinants that have created the disparities that have led to these profound situations.”
Several topics were covered when the event was opened up to audience questions:
The most-discussed audience question was how to create a virtuous cycle of continuous investment in addressing social determinants of health. Crittenden mentioned the implementation of a shared savings model and contract restructuring’s role. O’Neill mentioned the Essentials of Childhood initiative as promising but also illustrative of the challenge of moving resources across different organizations’ bottom lines. Accountable communities of health were also identified as a model that is showing a path forward in that area, despite being somewhat mired in process.
The question of how to achieve short term wins within a longer term measurement strategy was raised. Sharma said that developing a picture of health at a state level would require consistent data collection as well as improved data standards and metrics for success.
The role of policy and legislation arose toward the end of the session. Crittenden said a huge barrier is the need to change the system. He said that work is underway but we need to focus on continual improvement.
York’s comment summarized the reason for people to convene that afternoon best: when you can examine ROI on an individual basis, and not as an agency or organization, the ROI is significant on both the short term and long term level, and is also very visible.
“Our system is reinforcing the outcomes we are getting, and it’s doing so at all levels,” Erikson said. He finds the drive to value-based care encouraging. “If we don’t boldly take the system to a different place, it will not change itself,” he added.
Full video of the event is available on the Cambia Grove YouTube channel.
Read a recap of our second event in the series (on access to quality care) here.