Improving Social Determinants of Health Act of 2021: What CBOs Should Know


SDoH Act of 2021

The Improving Social Determinants of Health Act of 2021 is a landmark bipartisan bill with broad-based support from more than 400 healthcare organizations nationwide—and for community-based organizations (CBOs) across the country, it should be on the radar. If passed, the bill would give the Centers for Disease Control and Prevention (CDC) unprecedented power, largely in the form of grant money, to meaningfully change the way we think about and address SDoH in America. The bill would make available a minimum of $37,500,000 in annual grant money to CBOs and other groups working to address SDoH over the next five years. To be eligible, CBOs will need to demonstrate how they collaborate with:

  • Health systems
  • Payers like Medicaid and Medicare Advantage programs
  • Stakeholders in areas of need, like the Accountable Health Communities Model of the Centers for Medicare & Medicaid Services
  • Non-health related service providers, like those focused on transportation, housing, or food security

CBOs that want to take advantage of this new funding will need to start making small changes today, particularly around the five focus areas we've outlined below, all of which should be well within reach for most CBOs. Acting on them right now will help ensure broad-based alignment with the requirements of the bill in the event that it is passed.

1. Data collection and analysis

"Rich in member passion" is how one researcher classified the resources of most CBOs. The implication, of course, is that these groups are comparatively less well endowed in other areas. Advanced data collection and analytic capabilities, which are just now becoming priorities for many CBOs, are a case in point.

But the good news is, that's starting to change. Many CBOs are actively ramping up their data-collection efforts, having recognized that evidence-based approaches will open the door to broader partnerships that can amplify their overall impact down the road. Naturally, the adoption of these and other practices is happening in a piecemeal fashion, largely for two critical reasons: Few CBOs have the resources required to make such sweeping changes quickly, and the services they bring to so many communities across America on a day-to-day basis come first.

No matter where your CBO is in the data-adoption journey right now, you may want to formalize your approach, even if that means relying on relatively low-tech, say, pen-and-paper systems in the interim. Ultimately, whatever approach you deploy, you should be aware that data collection is going to be a key component of the eligibility requirements under the terms of the Improving Social Determinants of Health Act of 2021. In the language of the bill, "An eligible entity shall... propose a set of activities to address social determinants of health through evidence-based, cross-sector strategies." If you start preparing the evidence today, it'll be one less obstacle when it comes to funding.

2. SDoH best practices

This is an area where CBOs can and will stand out from the pack during the grant-award process, should the Improving Social Determinants of Health Act of 2021 get signed into law. Simply put, CBOs already have years of firsthand knowledge of and intimate familiarity with what works, and what doesn't, when it comes to effective screening for and treating SDoH—but are they documenting them?

If so, CBOs should take some time to review and refine their best practices as needed. If not, now is the time to get started. Just be sure to seek input from everyone on your team as you develop best practices, and try to balance your knowledge of what's effective with the client's perspective as well. And finally, to make the task a little bit lighter, bear in mind that this should be a living, changing document, not something set in stone.

This is critically important (as well as relatively low-hanging fruit) for CBOs because best practices are at the center of the proposed bill: Researching and disseminating "best practices to improve social determinants of health" is specifically called out as one of the high-level goals. As we know, CBOs are rich repositories of this kind of knowledge, and sharing it is an important part of the value they bring to the conversation around SDoH. So it's a good idea to start documenting or updating your own evolving in-house best practices today.

3. Cross-X Partnerships

If any word should be underlined in the proposed bill (besides "SDoH"), it's probably "cross." The word appears six different times, in a variety of formations—"working across sectors", "cross-cutting work" and so on—and the frequency with which this concept appears in the language of the Improving Social Determinants of Health Act of 2021 is something to take note of. 

Why? Because in no uncertain terms the goal of the bill is to promote greater integration between all players in and around the healthcare delivery ecosystem. The idea, which is not a new one to most CBOs, is that only through effective coordination between providers, payers, and CBOs can we effectively treat SDoH. So if your CBO has entered into partnerships in the past, think about what worked, the things that didn't—and what you'd like to change the next time around. And if you haven't, think about what factors have been holding you back, and see what you can do to minimize them. This will definitely be taken into consideration during the grant-award process.

In a related vein, it's worth pointing out that this overarching emphasis on integration and partnerships ties back to the concept of "scalability," too, which is explicitly one of the goals of the bill: "Developing scalable methods to meet patients’ social needs identified in clinical settings or other sites" is a stated aim.

Compiling and sharing best practices, obviously, is one piece of that. Partnerships are another. CBOs that can demonstrate aptitude or readiness in both areas will be the top contenders when it comes time for funding.

Next Steps

The Improving Social Determinants of Health Act of 2021 is a landmark piece of legislation, a bipartisan bill that boasts broad-spectrum support from health systems, advocacy groups, community organizations, and companies like Healthify from coast to coast. While its passage is anything but assured, a bill of this kind is frankly overdue. At present, for example, only 20 percent of the U.S. healthcare budget currently goes to services that address SDoH—despite the fact that these factors are known to be key drivers of more than 80 percent of health outcomes. The bill itself frankly acknowledges this gap in our current approach to healthcare:

  • "Medical care accounts for only 10 to 20 percent of the modifiable contributors to healthy outcomes for a population."

  • "Nonclinical, community-wide approaches... show positive health impacts, results within five years, and cost-effectiveness or cost-savings over the lifetime of the population or earlier."

  • And yet: "Health departments and the Centers for Disease Control and Prevention are not funded for such cross-cutting work."

If and when the Improving Social Determinants of Health Act of 2021 will be signed into law remains to be seen. What's also clear in the interim is that CBOs would be wise to look closely at the language of this bill, specifically around funding requirements, reexamine their own processes and practices, and double down on some of the key focus areas we've defined above. By doing so, they'll be better positioned to not only take advantage of new funding opportunities in the event that the bill is passed but collaborate and integrate with payers, providers, and other stakeholders in the healthcare ecosystem in the near term, too. If nothing more, that alone could go a long way toward driving SDoH impact at scale.

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Topics: public health healthcare policy population health sdoh

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