CMS & NIH Focus on Relationship Between Social Issues and Health of Seniors, Children

When patients come to labs for tests, they bring more than health needs. They may come from unstable homes, be hungry, or experience difficulty finding transportation to get to the lab.

Social issues like these have been researched and linked to health for decades. But the U.S. Department of Health and Human Services (HHS) has just announced two new initiatives that take a fresh look at the relationship. Labs, as a gateway to health care, can draw value from these efforts.

The Centers for Medicare & Medicaid Services (CMS), with $157 million in HHS funding, is launching a five-year program dubbed the Accountable Health Communities Model to explore among its beneficiaries a possible link between clinical services and social needs.

Also, the National Institutes of Health (NIH) is calling for research, through January 2017, aimed at reducing health disparities among children. An American Academy of Pediatrics (Academy) policy statement, released in March, calls early detection and management of poverty-related disorders important components of pediatrics.

For laboratory leaders, these efforts are important for at least two reasons. First, they may produce data that suggest difficulties in accessing lab tests, which is the gateway to care for many people. And the studies could encourage labs to develop community outreach services, or to partner with hospital social services departments or community agencies in healthy neighborhood initiatives. For example, some labs give staff responsibilities for assisting patients with interpreting insurance plans.

Here are details about the initiatives.

The CMS program is the agency’s first model aimed at beneficiaries struggling with unmet health-related social needs and helping them learn of community-based services that can help. As part of the program, “bridge organizations” will screen seniors and Medicaid beneficiaries to find out if they face issues such as housing instability, food insecurity, utility needs, interpersonal violence and transportation limitations, according to a CMS statement.

The 44 “bridge organizations” (hospitals, physician practices, community-based organizations and other award recipients) may help connect beneficiaries— who perhaps choose to pay an electric bill over going to the lab for a blood test—to services such as the Low Income Home Energy Program. “For decades, we’ve known that social needs profoundly affect health, and this model will help us understand which strategies work to help improve health and spend dollars more wisely,” said Patrick Conway, MD, CMS deputy administrator and chief medical officer, in a statement.

Effectiveness of the model will be assessed in reduced health care costs, emergency department visits and inpatient hospital readmissions, according to CMS.

NIH Funds Children’s Health Studies
Meanwhile, the NIH announced in December available funds to study factors that affect children’s health including: 1) lab-related areas of biological health—genetics, cellular and organ systems; 2) lifestyle factors 3) physical and family environments; 4) social; 5) economic; 6) institutional; and 7) cultural influences.

An NIH notice identifies these segments for studies: low literacy; rural and low-income populations; geographically isolated; hearing and visually impaired; physically or mentally disabled; migrant workers’ and immigrant and refugee family children; and language minority children.

Pediatricians Asked to Help Screen for Poverty
One in five U.S. children under age 18 lives in poverty, according to U.S. census data. And research links children in poverty with toxic stress that can alter gene expression and brain function and contribute to chronic cardiovascular, immune and psychiatric disorders, as well as behavioral difficulties, according to a policy statement by the Academy, ”Poverty & Children’s Health in the U.S.,” which appears in the April 2016 issue of Pediatrics.

Early detection and management of poverty is a part of the pediatrics practice, according to an Academy statement. The organization calls on pediatricians to ask at patient check-ups questions (aimed at identifying people who need help from community resources) such as, ”Do you have difficulty making ends meet at the end of the month?”

Takeaway: Two federal agencies are exploring social determinants of health and health disparities. CMS seeks to help its beneficiaries with community- based services that could improve their health. The NIH has funds to study diverse factors affecting children’s health and how they can be addressed. The American Academy of Pediatrics says detection of poverty and related disorders is part of the pediatrics scope of practice. Labs, as gateways to heath care, may see opportunities to reach out in healthy neighborhood initiatives.