By Sara Heath
- The American Medical Association added to its newly enacted policies, urging healthcare payers to address the social determinants of health through their benefits packages.
The policy, which AMA adopted during a Special Meeting of its House of Delegates, aims to supplement efforts clinical providers have already put forward in health equity and social determinants of health work, the organization said.
“Addressing social determinants of health requires an all-hands-on-deck approach that is not limited to stakeholders within the health care system. By addressing social determinants of health in their benefit designs and coverage, health plans can be part of the effort to improve patient health outcomes,” said David H. Aizuss, MD, a member of the AMA Board of Trustees.
AMA pointed to benefits policies from public payers like state Medicaid programs and Medicare Advantage that address social determinants of health. In 2019, the Centers for Medicare & Medicaid Services (CMS) expanded the scope of benefits for Medicare Advantage and Part D plans to include social care.
Those benefits, which Medicare Advantage could roll out in the 2020 plan year, could run the gamut of meal delivery, rides to the grocery store, or a service that would make one’s home more conducive to healthy living. For example, Medicare Advantage could subsidize an air filter for an individual living with asthma.
These programs have been effective, AMA suggested, and could paint a path forward for other private payers looking to address social determinants of health.
The AMA policy centered on five principles.
Foremost, the organization reaffirmed its stance that social determinants of health have a marked effect on patient health and wellness. AMA underscored its support for community health partnerships that help address social determinants of health and support patient health outside of the clinic or hospital.
Second, AMA said it supported continued programming from public and private payers to address social determinants of health.
Third, the policy touched on medical racism and implicit bias. AMA recommended public and private payers look at the role racism plays in healthcare and the social determinants of health. Many healthcare experts agree people of color are more likely to experience social determinants of health than their White peers.
Fourth, AMA asserted all stakeholders, clinicians, policymakers, and payers alike, need more patient data to better understand social determinants of health and whether programming has been effective at addressing them.
Finally, AMA stated healthcare stakeholders should develop pilot programs targeting certain social determinants of health for which there is little evidence. Such efforts could help build an evidence base for all non-clinical patient needs.
To their credit, public and private health payers have been driving work around social determinants of health. Most private payers have developed community health partnerships and standalone programming to address non-clinical factors affecting their beneficiary populations—partnerships with medical ridesharing companies or food pantries, for example.
Fewer have embedded SDOH and community health resources directly into benefits packages—a member may not produce a claim for visiting an affordable housing center the way she might for accessing primary care, for example.
This policy comes alongside other new AMA policies adopted during the November 2020 Special Meeting for the AMA House of Delegates. The organization likewise took a strong stance on medical racism, committing itself to anti-racism work.
“The AMA recognizes that racism negatively impacts and exacerbates health inequities among historically marginalized communities. Without systemic and structural-level change, health inequities will continue to exist, and the overall health of the nation will suffer,” AMA Board Member Willarda V. Edwards, MD, MBA, said in a statement announcing the policy.
AMA also asserted that race is a social, not a biological, construct, a big step toward unwinding implicit bias and structural racism in medicine. Clinicians treating biological differences between races has led to racial health disparities and racist treatment.
“By acknowledging that race is a social construct and not an inherent risk factor for disease, we can truly make progress toward our goal of attaining health equity for all patients,” AMA Board Member Michael Suk, MD, JD, MPH, MBA, explained. “The AMA will continue to strongly support policies and regulations aimed at eliminating barriers to care and protecting the health of our nation’s most vulnerable populations.”
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November 20, 2020
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