Will SDOH Follow DEI's Decline? 3 Warning Signs for Healthcare Leaders

Discover the three critical signals every healthcare leader and payer needs to watch — before reform efforts possibly unravel.

The question Will Post-Brian Thompson Reforms Go the Way of DEI? requires a precursor: Which way has DEI gone?

HR Daily Advisor, a companion site to HealthLeaders Media, covered these developments extensively throughout 2024 (February, April, July, September, October). This coverage included the creep of government anti-DEI sentiment into the corporate sector. The list of companies now abandoning their DEI posts is long and growing — from Big Retail and Big Auto (Walmart, Target, Ford) to Big Tech (Amazon, Google, Meta) to Big Macs (McDonalds).

Sarah Reynolds, CMO of HiBob and a nonbinary C-suite leader, notes: "For employees who identify as members of marginalized groups, an organization's focus on DEI&B — or lack thereof — can impact every stage of the employee lifecycle."

Similarly, for patients who identify as members of marginalized groups, a focus on health equity — or lack thereof — can affect every stage of life in general.

The backlash against DEI initiatives in the United States has intensified, driven by a combination of legal decisions, political actions, and cultural debates. So has the backlash against health equity initiatives. While DEI is largely a workplace reform, threats to sustained healthcare reform may not be far behind.

Looking for signals

KFF has identified several ways that eliminating federal diversity initiatives could affect racial health equity in the U.S.:

1. Dismantling Equity-Focused Health Programs. Ending DEI-driven efforts like CMS's Health Equity Advisory Committee and FDA diversity guidance could weaken efforts to reduce health disparities, especially those linked to systemic racism.
    
2. Suppression of Health Equity Data and Research. Cutting or changing public health data and questioning equity-related research makes it harder for the government to spot healthcare disparities, measure progress, or guide policy.

These scenarios may help answer the overarching question of this series — "Will Post-Brian Thompson Reforms Go the Way of DEI?" — using the lens of the social drivers of health (SDOH). These drivers are the non-medical factors that influence health outcomes and include stable access to food, housing, transportation, employment.

Before exploring this connection, it's important to note that DEI and SDOH are not the same.

"They are different concepts and workstreams," notes Trenor Williams, CEO and co-founder of Socially Determined.

"DEI initiatives start with race, ethnicity, gender, identify the inequities that exist among groups and aim to close those gaps and make healthcare more equitable. SDOH work includes identifying social risks and needs for a person or and/or intervening and helping to address those needs regardless of a person's gender, race, ethnicity or other criteria."

Even so, commitments to DEI, SDOH or the lack thereof could help predict the trajectory of other reforms that arise from traumatic events — and how likely they are to persist.

Signal #1: Threats to federal funding

As noted above, KFF reported that cutting federal diversity initiatives could dismantle equity-focused health programs. We may already be seeing one of the first examples.

On Apr. 10, CMS announced that it would end spending "that duplicates resources available through other federal and state programs or isn't directly tied to healthcare services [emphasis added]." Examples provided were $241M for non-medical in-home services like housekeeping and a $3.8M diversity medicine initiative — both linked to designated state health and investment programs (DSHP/DSIP) in New York.

DSHP/DSIP are examples of innovative 1115 waiver programs that address SDOH needs with services that Medicaid does not normally cover. CMS noted that this kind of spending "distracts from the core mission of Medicaid."

Signal #2: Threats to data

KFF also noted that suppressing equity-based data and research could suppress health equity itself. This data and research:

• has shown that 80% of medical outcomes are based on non-medical factors
• put social drivers of health in the national vocabulary
• helped fund and create programs to address them

Other research from the CDC shows that non-White populations are more impacted by adverse SDOH and health-related social needs (HRSN). This includes Black, multiracial, Hispanic, Latino, and American Indian/Alaska Native (AI/AN) populations with the disparities ranging from lack of social and emotional support to food, housing, and transportation insecurity to less access to medical coverage and care.

As suggested by KFF, the CDC notes that SDOH and HRSN data can help "monitor needed social and health resources in the U.S. population and help evaluate population-scale interventions."

Population health is central to another bellwether of healthcare reform: the Triple Aim.

Signal #3: Threats to the Triple Aim

Healthcare's Triple Aim is to improve population health, enhance patient experience, and reduce costs. Many of the reforms that UnitedHealth Group and The Cigna Group proposed after Brian Thompson's murder are related to these aims, including:

• Cost: United has proposed a 100% pass-through of PBM rebate discounts to health plan members while Cigna wants to make prescription drug costs more predictable.
• Experience: Both United and Cigna have proposed better access to and navigation of healthcare, including fewer prior authorization (PA) hurdles.

James Clear, author of Atomic Habits, wrote: "You do not rise to the level of your goals, you fall to the level of your systems."

It remains to be seen whether healthcare's reform goals will also fall to the level of their systems — because the industry very clearly has a systems problem, a topic HealthLeaders will explore next. Read the first part of this article here.