White House publishes social determinants of health playbook

In a time of social, political, and economic uncertainty, the Biden Administration is looking for a more coordinated approach to addressing the social determinants of health (SDOH) and their relationship to health and wellness outcomes. 

The new US Playbook to Address Social Determinants of Health will act as a policy guide for the myriad government agencies and private entities involved in helping America’s communities live healthier, longer lives, with a focus on integrating social services and public health more closely with the clinical healthcare system. 

“The US Department of Health and Human Services defines SDOH as ‘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,’” the document says. 

“The frequent organizational separation of health care from services such as housing or nutrition programs complicates efforts to address interconnected health needs. This Playbook lays out an initial set of structural actions federal agencies are undertaking to break down these silos and to support equitable health outcomes by improving the social circumstances of individuals and communities.” 

The initial efforts will center on three main pillars that will require enhanced collaboration from all segments of the government as well as healthcare systems, the health IT industry, non-profit groups, and a variety of social services stakeholders. 

Pillar 1: Expand data gathering and sharing

Improved data collection, seamless interoperability, and enhanced analytics capabilities will provide the foundation for the nation’s efforts to understand and address SDOHs in a proactive and comprehensive manner. The Administration recognizes that the healthcare and social services systems frequently struggle with lack of access to standardized data on SDOH factors, and is reiterating its commitment to working with the relevant partners to make it easier to collect, analyze, and apply insights from SDOH-related information. 

“Across the federal government, agencies are investing in their data collection and sharing infrastructure to accelerate interagency collaboration while preserving data security and privacy,” the report states. “Recognizing the foundational role of data to support future innovation, the Administration will expand the collection of SDOH data for health research.” 

Pillar 2: Support flexible funding to address social needs

Recognizing the interconnectedness of traditional clinical care and SDOH-related needs, the Administration is planning to make it easier to use federal funds and grants to address both sides of the coin at the same time.   

For example, state Medicaid directors have recently received guidance on how to better use funding to meet SDOH needs through managed care contracting and Section 1115 demonstration projects, the report points out, and hospitals have gotten updated information on how to use SDOH-related activities to qualify for tax exempt status. 

The government will continue to provide guidance and education to internal agencies and external partners on how to secure funds for projects that cross outdated barriers between health and social care. 

Pillar 3: Support backbone organizations

Healthcare providers are often highly motivated to integrate SDOH services into their offerings, but they lack the staff and resources to do so at scale. Instead, they rely on community-based organizations to pick up where they leave off – yet these groups are also frequently overwhelmed by demand and only loosely connected to partners in the same community. 

“Backbone organizations” can help by becoming dedicated relationship coordinators and personalized navigators for people moving through the SDOH ecosystem.    

To expand the presence and utility of backbone organizations, the Administration is launching a National Learning Community with educational and technical assistance, data security training, and support in payment operations for community care hubs. 

“Improving data collection is critical, so the Administration will support backbone organizations in identifying best practices for equitable data collection, protection, and sharing. Additionally, the Administration will continue ongoing programs that bolster organizations providing housing assistance, food access, free or low-cost legal resources, and more,” the report added. 

In conjunction with the release of the Playbook, the Department of Health and Human Services (HHS) has published a call to action that urges “all our partners to collaborate — no single sector can drive this type of change alone — so that together we can achieve a future in which everyone, regardless of social circumstances, has access to aligned, high-quality, person-centered health and social care systems that can improve health and well-being.” 

CMS has also contributed with a breakdown of available health-related social needs (HRSN) services and supports considered allowable for specific Medicaid and Children’s Health Insurance Program (CHIP) authorities. The document clarifies how states can integrate services such as housing support and nutrition services into existing program structures. 

“It is clear that the health of our people does not exist in a vacuum, but it is affected by our access to stable housing, healthy food, and clean air to breathe,” said HHS Secretary Xavier Becerra in an accompanying press release. “It is crucial for HHS to tackle health care and public health holistically by addressing patients’ social conditions. Today’s announcement will help to provide opportunities to improve equal access to health care for every American and make progress toward a health system that improves health care outcomes for all Americans instead of the advantaged few.” 

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.  She can be reached at jennifer@inklesscreative.com.