NQF, Aetna to Collaborate on Social Determinants of Health

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The partnership will seek repeatable, scalable models to present at a summit later this year.

The National Quality Forum (NQF) and the Aetna Foundation have launched a 9-month project to find ways to promote payment methods that reduce health disparities and by addressing how things like housing, transportation, and nutrition can be barriers to better health.

These “social determinants of health” are getting more attention than ever from health policy leaders and from Medicare and Medicaid. HHS Secretary Alex Azar outlined plans to move more aggressively in this area in a November 2018 speech, and CMS is expanding telehealth for many more types of visits to address transportation issues.

The United States spent $3.5 trillion on healthcare in 2017, or $10,739 per person; as a share of gross domestic product, that is 17.9% of the economy—far more than other developed countries. Yet all that spending has not created an equal playing field in healthcare access, and the realization that a person’s ZIP code has as much to do with health status as the quality of care received is driving conversations about how address the conditions where patients live, work, or attend school.


According to a statement from the NQF, conditions in a person’s environment account for 40% of health outcomes, “representing a significant opportunity to improve the health of the nation’s most vulnerable populations with better integrated services.”

“We know that a visit to the doctor will not improve the health of people who lack stable access to food, housing, or transportation,” Shantanu Agrawal, president and chief executive officer of NQF, said in a statement. “We are deeply committed to improving health equity and the outcomes for all people and communities in our nation.”

The partnership between NQF and the Aetna Foundation will look for pioneers around the country who are already making strides in addressing social determinants of health, whether they are payers or health systems, or even entire communities. The idea is to find those ideas that are repeatable and scalable. The best ones will be shared later this year at a summit, when the initiative will conclude with a call to action.

Finding ways to address social determinants of health is critical for both moral and financial reasons, as outlined in the December 2018 report from the United Health Foundation, America’s Health Rankings. The report found dramatic increases in mental and physical distress, drug deaths, and suicides; rising rates of chlamydia, and increases in cardiovascular deaths. Cancer is even a mixed bag; while mortality is falling overall, it is unchanged in many states, and disparities are increasing.

Payers, including Medicare and Medicaid, will be unable to afford increased healthcare spending unless they can find ways to prevent costs associated with poor nutrition and environments that fuel diabetes and cardiovascular disease, and that aggravate allergies and autoimmune disorders. Drug costs for these conditions are climbing, and most hit harder on people in poverty. More than 30% of adults have obesity, which is tied to a host of health conditions; obesity declines with income and education levels.

“We have a significant opportunity to improve the physical and economic health of the country by changing our priorities and focusing on how we address social determinants of health,” Garth Graham, president of the Aetna Foundation, a independent philanthropic arm of CVS Health, said in a statement.

NQF’s 20th annual conference will also take a deep dive into the topic when it convenes March 24-26, 2019, in Washington, DC. “Social Determinants of Health and the Role of Data,” is a topic on the agenda for the meeting, which takes place at The Mayflower Hotel.