Highlights of Outreach and Collaborative Efforts of the
Beneficiary and Family Centered Care - Quality Improvement Organization (BFCC-QIO)
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Attention Hospital Providers: Annual Physician Attestation for 2022 is due on or before December 29, 2023! To complete this requirement click here:
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The U.S. Playbook for Addressing Social Determinants of Health: The Pillars |
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Last week’s issue of The Livanta Compass briefly discussed the concepts of social determinants of health (SDoH) and health-related social needs (HRSN). The issue also looked at the recently published U.S. Playbook for Addressing Social Determinants of Health ("the Playbook"). In today's issue, The Livanta Compass takes a closer look at the three pillars of the Playbook and the actions the federal government is taking to address SDoH and HRSN.
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Pillar 1: Expand Data Gathering and Sharing |
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Advance data collection and interoperability among health care, public health, social care services, and other data systems to better address SDoH with federal, state, local, tribal, and territorial support.
The Playbook lists the following actions to work toward Pillar 1’s goal:
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Establish a centralized federal data working group. A coalition of agencies will establish the SDoH Data Working Group to leverage best practices and resources to incorporate interoperable SDoH data into national policy development and implementation and spur public and private investment in health information technology.
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Improve the responsible and protected exchange of sensitive individual health information across federal agencies. The U.S. Department of Health and Human Services (HHS) will expand privacy guidance materials and other resources to assist the healthcare industry in understanding its obligations under HIPAA and other privacy and confidentiality laws.
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Align federally administered programs to support SDoH information exchange and closed-loop referrals. HHS will encourage agencies to adopt national HIT (Health Information Technology) data standards and promote the adoption of non-proprietary, open-application programming interfaces to capture and exchange SDoH data and disseminate information on projects focusing on SDoH data exchange and health equity.
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Improve the capacity of backbone organizations to make effective referrals. The Administration for Community Living (ACL) and ONC (Office of the National Coordinator) will identify and disseminate scalable approaches to secure social needs data and share foundational elements for SDoH health information exchange, such as streamlining workflows for closed-loop referrals between social services and healthcare organizations.
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Reduce data gaps to serve those at increased risk of disparate health outcomes. HHS will partner with federal agencies, private partners, and public service organizations to reduce SDoH data gaps. Projects include pilot initiatives, a national pilot affinity group, and support toward finalizing the SDoH Clinical Care FHIR (Fast Healthcare Interoperability Resources) Implementation Guide.
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Illuminate disparities in localities with significant SDoH burden. The Centers for Disease Control and Prevention (CDC) plans to release SDoH data from the Behavioral Risk Factor Surveillance System SDoH/Health Equity module, which will be analyzed and eventually added to a collaborative health surveillance database that generates small area estimates of public health measures.
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Pillar 2: Support Flexible Funding for Social Needs
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Identify how flexible use of funds could align investments across sectors to finance community infrastructure, offer grants to empower communities to address HRSNs, and encourage coordinated use of resources to improve health outcomes.
The Playbook lists the following actions to work toward Pillar 2’s goal:
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Increase payment for assessing and addressing SDoH. Healthcare providers are integral components in evaluating and managing the social needs of their patients. In November 2023, Medicare finalized new codes and separate payments for clinical resources used for SDoH risk assessments.
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Reduce barriers to using grants to address HRSNs. OMB will continue to support the flexible use of various funding streams to address SDoH and HRSNs. HHS will continue to review funding and data reporting processes and feedback to reduce barriers that might deter organizations from applying for federal grants.
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Improve the accessibility of HHS grant funding. To increase applications from under-resourced potential grant recipients, HHS will conduct a comprehensive user experience study and assess the entire federal financial assistance lifecycle to identify root causes and solutions. HHS will create a detailed roadmap for using the results to prioritize accessibility to grant applications.
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Support expanded nutrition assistance through coordination with health and social care service programs. ACL and the Food and Nutrition Service (FNS) at USDA (U.S. Department of Agriculture) are working to develop resources highlighting best practices for funding at the state and local levels to enable a continuum of nutrition services. ACL also provides technical assistance to grantees explaining how grantees can combine ACL grants under the Older Americans Act with Medicare reimbursements for medical nutrition therapy to deliver nutrition services to older adults.
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Use data to foster hospital and health insurer investments in SDoH. CMS (Centers for Medicare & Medicaid Services) is taking innovative steps to encourage investment in addressing HRSNs, such as upfront payments, social risk adjustment, benchmark considerations, and payment incentives for reducing disparities or screening for social needs and coordinating with CBOs to address them.
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Support high-value hospital community benefits spending. The Internal Revenue Service (IRS) updated the instructions to Schedule H (Form 990), which guides hospitals on reporting activities such as community benefits and community-building programs, such as hospital spending on food security, nutrition, and other SDoH.
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Incorporate health equity guidance into CDC’s non-research notice of funding opportunity (NOFO) template. The CDC developed revisions to the existing non-research NOFO template to assist HHS offices in integrating evidence-based health equity approaches and SDoH interventions during the development stage of NOFOs.
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Pillar 3: Support Backbone Organizations
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Support the development of community backbone organizations and other community infrastructure to link healthcare systems to community service organizations.
The Playbook lists the following actions to work toward Pillar 3’s goal:
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Provide training and technical assistance to community care hubs through a National Learning Community. Through the National Learning Community, ACL and CDC support community care hubs through technical assistance, information and resource exchange, access to subject matter expert consulting, and training in relevant topics such as network administration and operations, health and housing partnerships, and payment for services.
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Award new funding to support community care hubs. In 2023, ACL disbursed a grant to fund a national Center of Excellence to provide technical support and facilitate collaboration between community care hubs and healthcare organizations. This funding also provides sub-awards to aging and disability organizations to support their community care hubs.
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Build backbone organizations to strengthen at-risk neighborhoods through the Choice Neighborhoods program. Administered by HUD (U.S. Department of Housing and Urban Development), the Choice Neighborhoods program supports backbone organizations that coordinate the network of health and social care services available in at-risk neighborhoods.
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Seed backbone organization infrastructure by enhancing access to legal services for patients at health centers. HRSA (Health Resources and Services Administration) will work with technical assistance organizations that provide training on integrating access to legal services into healthcare settings to strengthen the ability of HRSA-supported health centers to operate as backbone organizations and support the centers’ ability to care for their patients.
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Expand and disseminate SDoH-related research resources and training opportunities. The HHS National Institutes of Health (NIH) Community Partnerships to Advance Science for Society (ComPASS) Program will provide research training and capacity building in delivering and evaluating health equity structural interventions. NIH will also continue to expand and disseminate SDoH-related research resources and training opportunities to the scientific workforce.
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Inform backbone organization work through targeted research. The USDA will research the relationship between SDoH, particularly nutrition security, and health and economic outcomes to inform backbone organization agendas to ensure these localized organizations address current and pressing community needs.
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Increase technical assistance and build the capacity of backbone organizations to support communities, including with environmental justice needs. Multiple federal agencies established the Federal Interagency Thriving Communities Network to create a holistic government-wide framework for providing place-based technical assistance and capacity-building resources for urban, rural, and Tribal communities experiencing a history of economic distress and systemic disinvestment.
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Livanta Addresses Health Care Quality |
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One of the five domains of SDoH is healthcare access and quality. As a Medicare Beneficiary and Family Centered Care – Quality Improvement Organization (BFCC-QIO), Livanta is responsible for reviewing healthcare services paid for by Medicare. This ability is rooted in two main functions of the BFCC-QIO program: protecting a Medicare beneficiary's right to quality healthcare and ensuring the protection of the Medicare Trust Fund. Livanta's case review activities help ensure that healthcare providers deliver quality healthcare to Medicare beneficiaries. Through the quality of care complaint process, Medicare beneficiaries may file a formal complaint if they believe that a Medicare-certified healthcare facility failed to adequately prevent, recognize, or treat any condition.
If the physician reviewer determines that the facility has an opportunity to improve care, Livanta's quality team often provides training to the healthcare organization on professionally accepted standards of care and best practices. Additionally, healthcare providers can request education about several healthcare topics. To learn more about Livanta's quality of care review process, visit the website here: https://livantaqio.cms.gov/en/Beneficiary/Quality_Of_Care.
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This material was prepared by Livanta LLC, the Medicare Beneficiary and Family Centered Care - Quality Improvement Organization (BFCC-QIO) that provides claims review services nationwide and case review services for Medicare Regions 2, 3, 5, 7, and 9, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.
Livanta does not provide medical advice, diagnosis, or treatment. The content of this article is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.12-SOW-MD-2023-QIOBFCC-CP318
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