Practical guidance for assessing equity and the impact of social determinants on health outcomes

May 1, 2023 / By Yichen Zhang, PhD, Dawn Weimar, RN

In 2021, the Centers for Medicare & Medicaid Services (CMS) issued a new roadmap urging states to address equity and social determinants of health (SDoH) to improve outcomes. Many state Medicaid agencies accelerated the strategic planning process to both address outcomes and focus upon improving equity. As a Medicaid senior leader, where do you begin to outline a data-driven approach to support these iterations?

To explore this question and others, I interviewed Yichen Zhang, PhD, lead research economist at 3M Health Information Systems. She has led large quantitative analyses on Center for Medicare & Medicaid Innovation (CMMI) projects and shares her perspective on these complex issues. Dr. Zhang explains the principles of research design using claims and encounter data augmented with social determinants variables that may be available to many state Medicaid organizations.  

How do you design your study to support innovations such as a 1115 waiver program to determine areas of greatest need within your population and assess outcomes? Furthermore, how do we establish a foundation built on data that is flexible to accommodate a changing focus as multiple iterations ensue?

Dr. Zhang: While there is abundant literature on the effect that demographics and SDoH have on health outcomes, most studies are based on population-level social determinants data such as the social vulnerability index. We believe that a design constructed of person-level data is key. This avoids the issue of homogeneity common with an area aggregation index that applies an attribute to everyone in a given zip code for instance. A person-level analysis provides more precise findings conducive to future flexibility and actionability. For example, leveraging 3M methodologies, the 3M HIS clinical and economic research group is supporting an SDoH project with a state Medicaid agency in close partnership with sister public health, housing, justice and economic development agencies. This project examines disparities in person-centered health care outcomes while quantifying and layering in the extent to which the interaction of SDoH, demographics and health care services is associated with their variation. This will give us a baseline or foundational data that can further be sliced and diced as research indicates priority areas of focus, while solutions and policy iterate.

Want to learn more? Click here to continue reading the interview with Dr. Zhang and dive deeper into the following topics:  

• What data can be used when connecting SDoH and health outcomes?
• How do you accomplish an analysis of such a large amount of health outcomes data based upon various equity or SDoH factors?
• How do we make sure that we are comparing apples to apples?
• Are there any cautions for those wanting a baseline database to establish a foundation for innovation such as a 1115 waiver which will require annual outcomes assessment?
• How can technology help us with an equity assessment?

Dawn Weimar, RN, is regional director, state regulatory affairs for 3M Health Information Systems.

Yichen Zhang, PhD, lead health economics researcher for the clinical and economic research group of 3M Health Information Systems.