Understanding the U.S. Playbook to Address the Social Determinants of Health

The Biden Administration has released a new playbook addressing three “pillars” of emphasis related to the social determinants of health (SDoH), from the Domestic Policy Council’s Office of Science and Technology Policy. While acknowledging the extensive coverage of the evidence and the significance of the SDoH across various media outlets, this review aims to delve into the specific strategies and allocation of resources by the White House to support SDoH initiatives and advance health equity.

Pillar 1: Data Expansion

The first pillar is centered on expanding data acquisition and sharing. The Administration plans to achieve this by fostering enhanced interagency collaboration and standardization of social data collection methods. Key efforts include the establishment of a centralized federal data working coalition, overseen by the Office of the Federal Chief Information Officer within the Office of Management and Budget (OMB). The overarching objective is to adopt a “whole-of-government” approach toward SDoH data collection and management. This involves aligning regulations and leveraging purchasing power in both public and private sectors for health information technology.

Moreover, measures will be taken to protect the exchange of individuals’ sensitive health information across federal agencies, with an expectation of expanded privacy guidelines by the U.S. Department of Health and Human Services (HHS). Notably, the playbook also highlights the need to bridge connection gaps, emphasizing closed-loop referrals. A substantial focus is also dedicated to the “Enterprise-Wide Veteran Social Determinants of Health Framework Integrated Project Team” to address veterans’ SDoH-related needs.

Pillar 2: Flexible Funding for Social Needs

The second pillar emphasizes the allocation of flexible funding for SDoH investments within Medicaid. This involves providing states with guidance on the use of lieu of services and settings (ILOS) to enable managed Medicaid programs to offer optional alternatives to state-plan covered services.

The playbook provides a recap of HCPCS code G0136, which provides reimbursement for SDoH risk assessment. Furthermore, the funding expansion aims to bolster grant eligibility and enhance nutrition support programs such as the Supplemental Nutrition Assistance Program (SNAP), Women, Infants, & Children (WIC), and school-based meals.

Pillar 3: Backbone Organizations

The third pillar focuses on backbone organizations, which act as facilitators managing community-based partnerships across sectors like healthcare, social services, public health, and economic development. The playbook emphasizes training and technical assistance for community care hubs through the National Learning Community.

It also proposes new funding opportunities for growth and expansion, with a specific emphasis on supporting families, early childhood support, and at-risk neighborhoods. Additionally, it expresses a keen interest in enhancing legal services for patients at health centers and advocates for greater attention to environmental justice needs impacting health outcomes.

From a review of the playbook, it is clear that some of these projects have already been started, while others are still yet to be fleshed out for funding allocation; the question remains regarding how this will trickle down to healthcare organizations and communities. As of today, the message focuses on the importance of collecting meaningful SDoH data at both the patient level and macro levels, across agency sectors, for community impact, with intentions for future growth.

Healthcare funding and efforts will continue to focus on expanding healthcare coverage in non-traditional settings, such as street medicine, and bringing non-typical services into the health sector, such as housing assistance, meal delivery, and legal support services. The playbook concludes with an envisioned future “where health and social circumstances can be addressed holistically and equitably.”