FEATURE · SOCIAL DETERMINANTS OF HEALTH
on this, as a medical coder? And really also, data is also not collected in initial intake processes. And providers don’t really want to be held account- able for collecting such data.” “Bryan, could
Lauren Riplinger, J.D.
you share with the audience what The Gravity Project is, and how it might help?” Hagland asked. “We are involved in the
Gravity Project, especially around our social needs measure. It creates align- ment, and that’s pretty important in healthcare; and the Gravity Project involves the coding and interoperability level. And we do have a representative involved in the initiative. And I do think it will help, yes. The harder part is the funding and the implementation, and how we look at use cases in taxonomy. But it’s helping us all to start the conversa- tion. Nothing is perfect, so let’s not let the perfect be the energy of the good. Let’s really all go in one direction, together.” “Andrea and Tina, do you have any
thoughts about the broad, policy-level issues that Bryan and Lauren have just referenced?” “The challenge is where you get your
data,” Boudreaux emphasized. “The challenge is that piece of where you can share data. The primary care clinic, the school, the hospital, etc. The data-sharing really helps us. We’ve looked at, how can we say, it’s my case management call, but we’re sharing it with all our part- ners? There are children in the school district who do not get care at Children’s National; and my job is to ensure that they have access to that quality care as well. So we’ve established a partnership with Howard University Hospital; and we’ve established a partnership with some of our local FQHCs [federally qualified health centers] in the area, to
“I think the current administration is going to continue to prioritize the collection and use of this data; and I think that future administrations will do so as well. ”
— Lauren Riplinger
ensure that when we identify a need, we’re applying the resources, and getting those children connected. So, pulling that information and understanding that need, is critical; and then it’s critical to set local policies and institutional practice, around what we’re learning. Our chief diversity officer, who is phenomenal, says, we’re a data-driven practice. And when we collect data and don’t do any- thing with it, we’re missing making some connections. What we do with the data makes sure is critical to make sure we’re seeing better outcomes.” “I agree with everything that Andrea
just said,” Simmons said. “The data- sharing can be a huge barrier; you really want to coordinate care, and focus on the continuum of care. That’s one of the things we’re working very hard on, setting up processes for data-sharing with all of our community partners. From a broader perspective, any policy-level support will make it easier for us. We created our social-determinants screening tool and refined it; our first error we made was that we created drop-down options with yes/ no answers. And our coders told us we were missing so much.” “Where will we be as a healthcare
system, about five years from now?” Hagland asked. “I am very committed to improving care; I’m hopeful that we’ll continue to transform our reimburse- ment models,” Boudreaux said. “I’ve just completed my tenure with the Healthcare Transformation Task Force, an organiza- tion focused on transitions; all of our members have committed to value-based care delivery—large payers, providers. It’s the way we’re going to change health- care. Our system pays providers to see you when you’re sick; we don’t focus on wellness; we don’t have enough wellness- driven provisions in our payment system. My hope is that we will continue to move forward to reward wellness.” “And a part of that will involve collect-
ing and sharing data, correct?” Hagland said. “Per that, there was an interesting project at Michigan Health in Ann Arbor a few years ago. They had already been creating heatmaps around care delivery and wellness issues, and were already working at the zip code level; but a data analyst came and spoke to us about how you have to go even more granular, below the zip code level, to look at the health status of populations.” “I think the current administration is going to continue to prioritize the
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“We talk about being data- driven, but I want to remind us that while a lot of our conversation has been around quantitative data, there’s a lot of qualitative data in communities that can be utilized.” —Bryan Buckley, NCQA
collection and use of this data; and I think that future administrations will do so as well,” Riplinger said. “Value-based care models will increasingly emphasize the collection of SDOH data, and its use. CMS [the Centers for Medicare and Medicaid Services] is making it clear that they want to prioritize SDOH. But what keeps me up at night, and everyone has already referenced this, is that we can’t just have a goal of just data collection. Providers, nurses, case workers, all need to integrate this data into their work. We have to think about how we collect the data and then really apply it to care delivery.” “We talk about being data-driven,
but I want to remind us that while a lot of our conversation has been around quantitative data, there’s a lot of qualita- tive data in communities that can be utilized,” Buckley noted. “And that data is just as valuable for providing context, So you need to be talking to your community leaders, your faith- based leaders; they could have told you about the characteristics of specific neighborhoods; we need to always focus on people. Let’s make sure we’re diversifying the groups of people we’re talking to. One of the organizations that NCQA has just become involved in is the Rise Up Health Coalition. And we want to make sure we keep health equity in mind. And we need to think about our public health infrastructure, and getting public health involved. We also need to rethink our processes. How are we processing, and whom is our process privileging? Whom are we centering on—the organization or the people? And let’s focus on people. I always tell people to start somewhere. And what’s the story we’re going to tell ourselves, and our communities, about how we addressed health inequities?” HI
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