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Bipartisanship Might Come on Social Determinants and Long-Term Care

Bipartisanship Might Come On Social Determinants And Long-Term Care

We have heard about the significant impact of social determinants of health (SDOHs). Studies find that these non-clinical factors – where one lives, food security, access to permanent, secure housing, transportation access, social and family supports, literacy and more – are as or more predictive of costs and outcomes than underlying co-morbidities. And now the Trump administration is signaling that it wants to tackle their negative consequences.

In addition, as we have noted often in our blogs, long-term care costs are becoming alarming, with a concentration of individuals at the high-cost services (e.g., nursing homes). State budgets especially are bleeding here as more and more healthcare spending (due to inflation and aging) is eating up other healthcare and non-healthcare dollars. Here, too, there are signals that the administration wants to recalibrate spending toward alternatives to institutionalization, such as assisted living, congregate housing, and home care.

In a recent speech, Secretary of Health and Human Services (HHS) Secretary Alex Azar summarized the huge impacts of SDOHs quite compellingly: “Social determinants of health is an abstract term, but for millions of Americans, it is a very tangible, frightening challenge: How can someone manage diabetes if they are constantly worrying about how they’re going to afford their meals each week?” Azar committed to working to align healthcare investments with those government resources targeted to SDOH areas. And there are major areas of federal government investment: Section 8 housing supports, federal block grants for housing and energy assistance, low-income housing tax credits, the SNAP or Food Stamp program, federal transportation subsidies, to name a few.

In a follow-up speech on long-term care, Azar was just as poignant: “An individualized approach is especially important to supporting Americans with serious health care needs in their homes, rather than in an inpatient facility. No American should be in a nursing home who doesn’t need or want to be — but helping Americans stay in their homes is an incredibly complex challenge. Where one person may need more attention from a skilled nurse, another needs modifications to his home or help preparing meals.” The new policy change allowing Medicare Advantage plans to use their funds to support seniors in homes is one great step. But Azar’s message, while obvious from a policy sense, is a political blockbuster.

We are now optimistic. Imagine if the administration did come together with Democrats and Republicans in Congress to forge a coherent strategy on both SDOHs and long-term care. Back in my days in Connecticut state government, I led an interagency task force covering long-term care that also touched some SDOH issues, especially housing. We broke down barriers in how healthcare and non-healthcare dollars were used. We built meaningful access by combining funds to support seniors and the disabled to live permanently in the community. We found this not only saved acute and long-term care spending (immediately and certainly over time), but that it had so many ancillary impacts – improved outcomes, financial and emotional relief for family members taking care of loved ones, and so on.

So our message to lawmakers as they contemplate the New Year and their legislative agenda: Carpe Diem! Bipartisanship could not start with two better issues.

Marc Ryan

Marc S. Ryan serves as MedHOK’s Chief Strategy and Compliance Officer. During his career, Marc has served a number of health plans in executive-level regulatory, compliance, business development, and operations roles. He has launched and operated plans with Medicare, Medicaid, Commercial and Exchange lines of business. Marc was the Secretary of Policy and Management and State Budget Director of Connecticut, where he oversaw all aspects of state budgeting and management. In this role, Marc created the state’s Medicaid and SCHIP managed care programs and oversaw its state employee and retiree health plans. He also created the state’s long-term care continuum program. Marc was nominated by then HHS Secretary Tommy Thompson to serve on a panel of state program experts to advise CMS on aspects of Medicare Part D implementation. He also was nominated by Florida’s Medicaid Secretary to serve on the state’s Medicaid Reform advisory panel.

Marc graduated cum laude from the Edmund A. Walsh School of Foreign Service at Georgetown University with a Bachelor of Science in Foreign Service. He received a Master of Public Administration, specializing in local government management and managed healthcare, from the University of New Haven. He was inducted into Sigma Beta Delta, a national honor society for business, management, and administration.

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