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Azar Outlines HHS Ambition on Social Determinants of Health: 5 Takeaways

Analysis  |  By Steven Porter  
   November 14, 2018

Medicaid-funded housing could be on the horizon, as the Trump administration looks to push toward value-based care. 'I want you to stay tuned,' the HHS secretary said.

As the healthcare delivery system moves toward a value-based model that rewards quality over quantity, the federal government has ambitions to lead the charge with innovative strategies to improve social determinants of health.

During a speech on Wednesday, Health and Human Services Secretary Alex Azar said the department he oversees is logically positioned to think of healthcare as broad and interconnected with other needs.

"Social determinants would be important to HHS even if all we did was healthcare services, but at HHS, we cover health and human services, all under one roof," he said in his prepared remarks. "In our very name and structure, we are set up to think about all the needs of vulnerable Americans, not just their healthcare needs."

Here are five big takeaways from the speech, which was delivered to the Hatch Foundation for Civility and Solutions in Washington, D.C.:

1. Housing Costs Could Be Covered

Azar went so far as to strongly hint that forthcoming models from the Center for Medicare & Medicaid Innovation (CMMI) could include public reimbursement for housing costs.

"What if we provided solutions for the whole person, including addressing housing, nutrition and other social needs?" he said. "What if we gave organizations more flexibility so they could pay a beneficiary's rent if they were in unstable housing, or make sure that a diabetic had access to, and could afford, nutritious food?

"If that sounds like an exciting idea … I want you to stay tuned to what CMMI is up to."

(In a separate speech Wednesday evening, Azar put a finer point on this hint: "We are actively exploring how we could experiment with actually paying for non-health services, like housing and nutrition—an integrated, individually driven approach to health and human services on a scale that has never before been tried in the United States," he said.)

2. Feds Won't Abdicate Leading Role

Azar was clear that his ambitions around social determinants are about better aligning federal spending, not handing the reins off to another entity entirely.

"There are a variety of reasons why the federal government takes the lead on financing healthcare, and that is not about to change," he said. "But we believe we could spend less money on healthcare—and, most important, help Americans live healthier lives—if we did a better job of aligning federal health investments with our investments in non-healthcare needs."

3. Local Needs Should Drive Solutions

Azar said it should come as no surprise that the Trump administration is thinking about healthcare improvement in a way that appreciates the nation's decentralized system and traditional involvement of the private sector and civil society. That framework extends, he said, to devising value-based solutions.

"One approach to social determinants of health would be, for instance, to say that we should identify a couple of the most common needs—like nutrition or housing—and really focus on investing in those," he said. "But that's not going to be of great use to someone in, say, a rural area, where food and housing may be affordable but finding a ride to their healthcare provider is the real challenge.

"That's why we don't believe in a rifle-shot approach to human services: You can't focus on one or two needs to the exclusion of others," he said.

4. Expect More From Medicare Advantage

Azar expressed an eagerness to tackle social determinants of health through the Medicare program and said Medicare Advantage (MA) represents "one of the best ways" the government can do that.

"Because MA plans hold the risk for their patients and they compete for their patients' business, they have an incentive to offer benefits that are both appealing to their members and that will bring down health costs—whether those benefits are traditionally thought of as health services or not," he said.

"The key is just that we need to give them the flexibility to do this, which we generally haven't done."

Azar noted that MA plans will be permitted next year to begin paying for a wider range of health-related benefits, including home health visits and transportation. That leeway will expand further in 2020, he said, when MA plans will be able to cover home modifications, meal deliveries, and more.

5. Building on Mental Health Initiatives

Azar mentioned that HHS and its agencies are building on a foundation that has already begun to address some major drivers of healthcare utilization, including the need for mental health and substance use treatment.

"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," he said. "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.

Editor's note: This story has been updated to include a quote from Azar's related speech on Wednesday evening.

“What if we provided solutions for the whole person, including addressing housing, nutrition and other social needs?”

Steven Porter is an associate content manager and Strategy editor for HealthLeaders, a Simplify Compliance brand.


Pay attention to what's coming from the Center for Medicare & Medicaid Innovation. It could include coverage for housing costs.

Expect movement on Medicare Advantage, which Azar described as 'one of the best ways' the government can influence social determinants of health.

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