CMS call to action on social determinants of health

Jan. 18, 2021 / By Private: Katie Christensen

CMS has indicated that social determinants of health (SDOH) are not just an adjunct element to our health care ecosystem, but are increasingly driving the definition of health care itself and the subsequent payment model.  Health care professionals are being called on to manage the impact of social risks on the health of individuals and high-risk populations. Social risks include lack of housing or homelessness, unemployment, food insecurity, lack of transportation and other factors.

I recently read a compelling statement by CMS administrator Seema Verma, addressing the role of social determinants in overall health:

“The evidence is clear: social determinants of health, such as access to stable housing or gainful employment, may not be strictly medical, but they nevertheless have a profound impact on people’s wellbeing,” 1

Making the case that SDOH are correlated with better health outcomes may not be a provocative statement at this point. The following language by CMS suggests that social determinants represent a core component when designing a value-based program that will lead to better outcomes.

The purpose of this State Health Official (SHO) letter is to describe opportunities under Medicaid and CHIP to better address social determinants of health (SDOH)1 and to support states with designing programs, benefits, and services that can more effectively improve population health, reduce disability, and lower overall health care costs in the Medicaid and CHIP programs by addressing SDOH …  the growing shift towards alternative payment models and value-based care has accelerated the interest in addressing SDOH within Medicaid and CHIP in order to lower health care costs, improve health outcomes, and increase the cost-effectiveness of health care services and interventions. 2

CMS is providing insight into the pivotal role that social determinants play in any value-based care initiative to achieve better outcomes in relation to overall health care spend. This transformation is crucial as we continue to see rising costs and poor outcomes. 

“Americans suffer higher death rates from smoking, obesity, homicides, opioid overdoses, suicides, road accidents, and infant deaths. In addition to this, deeper poverty and less access to healthcare mean Americans at lower incomes die at a younger age than poor people in other rich countries.”3

We are being called on to know:

Know your population and know their social determinants of health. Reach out and address care coordination needs. Establish relationships and build out programs with community-based organizations. Manage to social risk. We can all be a part of creating more equitable care for everyone.

Katie Christensen is a healthcare consulting manager within the Population and Payment Solutions group of 3M Health Information Systems.

  2. Social Determinants of Health (SDOH) State Health Official (SHO) Letter (