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NQF, Aetna join forces to tackle social determinants


The National Quality Forum and Aetna Foundation on Thursday launched a nine-month initiative to identify best approaches toward addressing social determinants of health to develop a national standard of effective strategies for payers and providers.

The initiative, according to NQF President and CEO Dr. Shantanu Agrawal, is the continuation of an effort the two groups began in 2017 when they outlined in a Health Affairs blog post that there needed to be a more uniformed approach to collecting evidence-based data on the health impact of social factors such as poverty, housing instability, food insecurity and violence.

But data on outcomes and interventions has been mixed, according to Dr. Garth Graham, president of the Aetna Foundation.


“There is a heterogenous if not mixed lay of the land in terms of both local and national strategies and not a lot of uniformity in terms of understanding what works and being able to expand on what works and understanding what doesn’t work and why,” Graham said, “The idea here is to try to get an understanding of what is happening and what are the kinds of interventions that should be explored further.”

The initiative will review articles and conduct expert interviews to find interventions that can be scalable and reproduced, Agrawal said. They will hold a summit later this year to develop an action plan.

“We are really trying to pivot from knowledge to action so that we are empowering other stakeholders to take the actions they can take based on understanding the best science and best data,” Agrawal said.

The effort is being funded through CVS Health’s “Building Healthier Communities” initiative. Last week, CVS Health pledged $100 million over the next five years toward improving community health and wellness following its $70 billion acquisition of the health insurer.

Tackling social determinants of health has been a growing priority among hospitals and health systems as it became clear that social factors affect health outcomes and create haelth disparities between lower-income and more affluent patients.

The ongoing shift from fee-for-service payment models to reimbursement based on outcomes has prompted many hospitals to encourage prevention and wellness efforts to reduce healthcare utilization and expenditures. Those initiatives have included providing patients with fresh food, transportation to and from medical appointments as well as community-wide interventions to address issues such as housing and economic revitalization in impoverished areas.

But there has been no consensus over whether individualized or community-based approaches are more effective. Most providers only take initial steps toward addressing social determinants.

A 2017 survey by the Deloitte Center for Health Solutions of 300 hospitals and health systems found 88% reported they were committed to addressing social determinants yet 72% had not made any investments. Nearly 40% said they did not measure outcomes of their initiatives.

Implementing interventions that address social determinants can also be costly since they are often not reimbursed, which often makes it cost prohibitive for smaller providers with limited resources.

Agrawal said one of the goals of the initiative was to find interventions that providers of all sizes could implement.

“I think part of this is really figuring out how payer and provider alignment can work so that even you small provider that might be more limited in resources is able to do something,” he said.