November 19, 2018 – Speaking at the Hatch Foundation for Civility and Solutions in Washington, DC, early this month, Azar pointed to social determinants of health as “the root cause of so much of our health spending,” contributing to the $1 trillion in annual spending by the federal agency on the elderly and vulnerable Americans.
While the head of HHS noted the federal government assumes the lead on financing healthcare, “we believe we could spend less on healthcare.” And, most importantly, he continued, “we can help Americans live healthier lives if we did a better job of aligning federal health investments with our investments in non-healthcare needs.”
The lack of alignment has created and sustained a fragmented and inefficient ecosystem for individuals to receive meaningful care.
Many federal programs for low-income Americans, like nutrition and housing, do not live within HHS,” Azar remarked. “Moreover, human services and healthcare programs for vulnerable Americans are often administered at the state level — states run Medicaid, cash welfare, subsidized childcare, Head Start, and many more such programs. On top of all that, much of the support our country provides to struggling Americans does not flow through government: It’s provided by churches, charities and other nongovernmental organizations, which are frequently tasked with helping the sick and poor navigate the eligibility requirements, application timelines, benefit thresholds, and other complicated elements of our nation’s safety net programs.”
Azar highlighted several initiatives undertaken at HHS to address the high costs associated with failing to address social determinants of health.
The Center for Medicare & Medicaid Innovation (CMMI) established the Accountable Health Communities to screen high utilizers for food insecurity, the risk of domestic violence, and transportation- and housing-related difficulties.
“Like all CMMI models, this will be carefully assessed to see whether this is an effective way to meet these non-health needs, and whether making these connections improves health and decreases health spending,” said Azar. “A model like this can take advantage of two key aspects of our decentralized, flexible system: the individualized approach it enables and the incentives we can offer to private-sector service providers.”
The HHS Sectary, however, did warn against limiting the focus to one or two social determinants of health “to the exclusion of others” by calling for models that connect individuals to the specific services their unique situations require rather than “offering a one-size-fits-all approach.”
Azar highlighted accountable care organizations (ACOs) as having a significant interest in this model as an opportunity to drive down cost so long as incentives cover a provider’s investment in a truly holistic approach to patient care.
The head of HHS also pointed to addressing substance abuse in two other CMMI models — Maternal Opioid Misuse (MOM) and Integrated Care for Kids (InCK) — that alongside efforts to combat serious mental illness and other complex mental health conditions can have a positive impact on the lives of individuals and reduce waste. Existing and new Medicaid waivers should go a long way toward remedying these sources of misalignment.
“For decades now, Americans with serious mental illness have been poorly served by our health system — first, by an inhumane system of institutionalization, and now, by a system that fails to provide them with what they need to live healthy lives in the community,” Azar noted. “With these waivers and other work across the administration, we believe that can begin to change — and we can enter an era where serious mental illness is treated as effectively as any other health condition.”
The HHS Secretary emphasized the need to address the health needs of vulnerable populations ahead of healthier populations entering the most health-sensitive eras of their lives. As such, he hailed the work of Medicare Advantage plans to give payers and providers greater flexibility in caring for their patients.
“The key is just that we need to give them the flexibility to do this, which we generally haven’t done. But starting next year, plans will now be allowed to pay for a wider array of health-related benefits, such as transportation and home health visits,” he stated.
“These interventions can keep seniors out of the hospital, which we are increasingly realizing is not just a cost-saver, but actually an important way to protect their health, too,” he continued. “And if seniors do end up going to the hospital, making sure that they can get out as soon as possible, with the appropriate rehab services, is crucial to good outcomes and low costs as well.”