Highlights of Outreach and Collaborative Efforts of the
Beneficiary and Family Centered Care - Quality Improvement Organization (BFCC-QIO)
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Understanding Health Outcomes: The U.S. Playbook to Address Social Determinants of Health
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Social determinants of health (SDoH) are a familiar topic for many professionals within the healthcare landscape. For example, several years ago, the Centers for Medicare & Medicaid Services (CMS) established Z codes to identify and track individuals' social and economic difficulties and support research into SDoH and the resulting inequities. Government agencies, healthcare providers, and others have already made numerous efforts throughout the healthcare landscape to improve health outcomes for all Americans – although more work needs to be done. As part of a nationwide effort to improve health outcomes for all Americans, in November 2023, the Domestic Policy Council and the Office of Science and Technology Policy published The U.S. Playbook to Address Social Determinants of Health (“the Playbook”).
This issue of The Livanta Compass explores the concepts of SDoH and health related social needs (HRSN) and dives into the Playbook.
CMS, “Utilization of Z Codes for Social Determinants of Health among Medicare Fee-for-Service Beneficiaries, 2019”
The U.S. Playbook to Address Social Determinants of Health
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Understanding Social Determinants of Health and Health Related Social Needs |
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Several factors that impact health outcomes fall under the term social determinants of health, often called SDoH. SDoH are “the conditions in the environments where 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,” as defined by the U.S. Department of Health and Human Services (HHS) in Healthy People 2030. SDoH exist at the community level and influence individuals' health related social needs (HRSN). These HRSNs often include an individual patient’s economic strain, lack of food, poor housing, unsatisfactory education, and inadequate access to health care. Unmet HRSNs can lead to worsening health outcomes, especially related to health conditions such as diabetes, heart disease, depression, and cancer. |
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According to Healthy People 2030, SDoH fall into five categories: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context. Research regarding SDoH has led to a more focused effort in understanding the HRSNs of individuals. CMS categorizes these needs into five domains: housing instability, food insecurity, transportation problems, utility help needs, and interpersonal safety. CMS has added eight supplemental domains, including financial strain and employment, family and community support, education, physical activity, substance use and mental health, and disabilities. In fact, according to the Playbook, socioeconomic factors such as poverty, the prevalence of jobs paying a living wage, and education have the most significant impact. Furthermore, food insecurity can cause an increased risk of chronic illness.
Healthy People 2030
CMS, “The AHC Health-Related Social Needs Screening Tool”
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The Playbook was developed to “create a scaffolding upon which entities from all segments of society can build.” It sets out the framework for both government and non-government agencies and organizations to build bridges between the often siloed health care and community services that can help meet HRSN. According to the Playbook, addressing SDoH requires the effort of all segments of society, including government, philanthropies, businesses, academic organizations, community-based organizations, non-profits, and faith communities. In addition to structural inequities such as lack of adequate food, housing, and transportation, historically underserved populations are frequently disproportionately impacted. Some of these populations include Blacks, Latinos, Native Americans, Pacific Islanders, LGBTQ+, women, and individuals in many other communities. For example, people of color have higher rates of diabetes, obesity, asthma, and other conditions than their non-Hispanic White counterparts. Although the list of SDoHs that impact health outcomes is long, four specific issues that the Playbook highlights are housing security, food security, education access, and a healthy environment.
One of the most significant SDoH is housing security, as inadequate housing can increase individuals' risk of lead poisoning, extreme temperatures, unsanitary conditions, and other issues. Inadequate housing can include paying more than half of a household's income for rent or living in severely deficient conditions. Lack of affordable housing also increases the risk of homelessness. The Playbook notes that various environmental and social factors can impact an individual's food security, such as the location of grocery stores, the cost of nutritious food, and transportation to grocery stores. Food insecurity can increase the risk of obesity, diabetes, heart disease, and other health conditions. Like other SDoHs, food insecurity often disproportionately affects people of color due to both historical injustices and current inequities. According to the Playbook, additional levels of education can lead to higher incomes, job stability, and access to health coverage, which can lead to improved health outcomes.
The last focus area in the Playbook is a healthy environment, which means a safe and sustainable place where individuals live, work, learn, play, and worship. However, many communities face environmental justice concerns, such as racial discrimination, redlining, and discriminatory land use decisions. Pollution, hazardous waste, and other toxic exposures often affect communities that also face food insecurity, housing insecurity, and inadequate educational opportunities.
The Playbook is comprised of the following three pillars:
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Expand Data Gathering and Sharing: 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.
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Support Flexible Funding to Address Social Needs: 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.
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Support Backbone Organizations: Support the development of community backbone organizations and other infrastructure to link healthcare systems to community-based organizations.
Using these three pillars as a launchpad, the Playbook's framework serves as guideposts for organizations across society to coordinate efforts to improve the delivery of health and social services. Watch for next week’s issue of The Livanta Compass for a closer look at these three pillars.
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Livanta Addresses Beneficiary Concerns Through Immediate Advocacy |
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Immediate Advocacy is an informal mediation service provided by Medicare's Beneficiary and Family Centered Care-Quality Improvement Organizations (BFCC-QIOs) like Livanta for Medicare patients and caregivers experiencing healthcare problems. The process begins when a beneficiary or caregiver calls the BFCC-QIO Medicare helpline and asks for help resolving an issue, such as difficulty communicating with their health practitioner. After discussing how the Immediate Advocacy service works, Livanta's review coordinator obtains verbal consent from the caller and further explores the nature of the problem. With a clear understanding of the stated challenge, barrier, or other problem, Livanta's review coordinator then contacts the provider or practitioner on behalf of the Medicare patient. From there, Livanta's Immediate Advocacy staff work collaboratively with patients, caregivers, and healthcare providers until a resolution is reached. Most cases are resolved within three or four days. Immediate Advocacy can address a wide array of issues, including problems such as (but not limited to) communication issues, concerns about discharge or treatment plans, medication issues, or medical supply issues.
Immediate Advocacy is a critical component of the QIO Program. Immediate Advocacy is genuinely a patient-centered service, and it helps to support the triple aim of better health, better care, and lower cost. Medicare beneficiaries and their families and caregivers can access Medicare’s Immediate Advocacy service through the BFCC-QIO Program. As one of Medicare’s BFCC-QIOs, Livanta provides this service at no cost to Medicare beneficiaries and their families and caregivers in 27 states and territories. Immediate Advocacy can address problems in any care setting that accepts Medicare, so beneficiaries experiencing issues with their care can get assistance from Livanta.
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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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