Social Determinants of Health (SDoH)—the conditions in which people are born, live, play, learn, work, worship, and age affecting a wide range of functioning, health, and quality-of-life outcomes and risks, and the systems that shape those conditions—are increasingly receiving attention.
Maryland is one of the states that are accelerating efforts to improve SDoH. Experts across the region’s healthcare landscape gathered at the 2023 Maryland State of Reform Health Policy Conference in person at the Baltimore Convention Center to discuss initiatives to address SDoH and health equity.
Among the panel members were Sec. Laura Herrera-Scott of the Maryland Department of Health, Pres. Vinny DeMarco of Maryland Citizens Health Initiative, Vice-Chair Bonnie Cullison of the Health and Government Operations Committee, Del. Nicholaus Kipke of the House Health and Government Operations Committee, and Dr. Josh Sharfstein, the Vice Dean at the Johns Hopkins Bloomberg School of Public Health’s Public Health Practice and Community Engagement.
Several executive directors were part of the panels, too, including Andrew York (Maryland Prescription Drug Affordability Board), Jennifer Briemann (Maryland Managed Care Organization Association), Shannon Hall (Community Behavioral Health Association of Maryland), and Angelo Edge (Aetna Better Health of Maryland). Linda Henderson-Smith (Carelon Behavioral Health) and Venkat Koshanam (Maryland Health Benefit Exchange) also took part in the Conference.
Examples of the initiatives discussed were those implemented by Aetna Better Health of Maryland, such as opening health education centers focusing on SDoH. CEO Angelo Edge also mentioned that their organization is taking contracting with rideshare organizations into consideration. They believed it could fill the gaps for non-emergent medical response provisions, including patient screenings, care coordination, and patients’ connection to social needs resources. It’s another way to incentivize healthcare providers through coordination fees on a sub-capitation basis.
One of the concerns discussed at the Conference is the accessibility to services. Deputy Director Suzanne Schlattman of Maryland Healthcare for All said they continue to hear about transportation and prescription drug affordability issues from the residents during their community outreach. Above all, she highlighted the issue of drug affordability.
Schlattman pointed out that Maryland has the Prescription Drug Affordability Board, an independent state agency that sets upper payment limits (UPL) on prescription medicines. The region became known as the first in the nation to establish this initiative. However, until now, many Marylanders have yet to experience a drop in their prescription drug costs.
She added that this prescription drug affordability is a top-of-mind concern among Marylanders. High costs affect personal and family budgets, affecting whether families can afford food or pay rent. She emphasized that healthcare costs affect all things, including the schools children attend.
Fortunately, many non-profit organizations and companies have been helping consumers to afford medicines. For example, they can Get Discounts on Protonix (for stomach and esophagus problems), Lisinopril (to treat high blood pressure), Synthroid (to treat hypothyroidism), and other common prescription medicines.
Schlattman said their board is working with Nexus Montgomery, a hospital-led collaborative. Nexus Montgomery works with six hospitals in Montgomery County to promote health and reduce unnecessary or avoidable hospital use. They manage a dynamic portfolio of programs operated by the Primary Care Coalition (PCC), an organization that specializes in operationalizing multi-partner initiatives in Maryland.
This partnership between Maryland Healthcare for All and Nexus Montgomery aims to address SDoH and health equity through workforce development. Specifically, they focus on getting people certified in hard-to-fill positions, such as certified medical and nursing assistants.
The pair will cover the participants’ tuition and ensure they’re successful in certification programs by getting hands-on help from community health workers. They will also offer career counseling, including advice on how the participants advance their careers to earn higher salaries and solutions to transportation issues.
Another primary concern is the lack of Marylanders’ understanding of SDoH and health equity. CEO Natalie Burke of CommonHealth ACTION said that while there’s a statewide narrative happening in pockets, collective consciousness on SDOH and health equity is imperative. This encourages the community to engage meaningfully in their health.
Although the state has a high population of educated people and many academic facilities, many Marylanders are still unaware or not completely aware of what they should be expecting from health equity. Besides a lack of understanding, there’s also an ongoing misconception of not needing to invest in health equity.
Burke underscored that if health equity literacy isn’t framed as a basic human need, then the government and the health leaders are failing. She added that it’s seemingly a disservice to Marylanders and other communities if the government doesn’t invest in health equity literacy.
Coordination across the citizens, health leaders, and the government is crucial to achieving these initiatives. SDoH and health equity are cut across various focus areas, so it would be addressed better when disparate stakeholders, including taxpayers, healthcare providers, communities, celebrities, and other agencies, unify and work together.