Module #4: Top 3 Social Determinants of Health (SDoH) Housing/ Neighborhood Environment For more information on TCPI SANs please use this link: http://www.tcpisan.org/

HCDI Overview HCDI-SAN Learning Library: Top 5 (SDoH) Overview HealthCare Dynamics, International – founded and led by clinicians 25+ years supporting CMS quality and population health programs NICHE: Policy to Practice Strategy focused on health care delivery systems and the quality/cost for vulnerable populations Customized learning and action platforms focused on clinicians, patients and health care systems HCDI-SAN Learning Library: Top 5 (SDoH) Overview Housing/ Neighborhood Environment The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities These social factors may also affect the patient’s ability to self-manage and adhere to their shared decisions. Looking at SDoH data can help practitioners better recognize the root causes that affect population health.

Learning Objectives: Social Determinants of Health- Housing/ Neighborhood Environment Upon completing review of this slide-deck presentation, participant will be able to: Define the relationship between ‘home and health’ Understand the influence of proper housing/ neighborhood environment in determining an individuals overall health status Describe the interacting constructs that make housing/ neighborhood environment a top SDoH Conceptualize the prevalence of housing insecurity nationally

Overview: Social Determinants of Health SDoH also refers to the bigger set of forces that shape the conditions of daily life of an individual. These forces can be social norms, culture, social practices, economic policies, developmental agendas along with political systems of any state/nation SDoH are considered as the root cause of our health and disease. Often times it is also known as the ‘cause of the cause’.

Housing and Health When considering the Social Determinants of Health, housing refers to more than just a physical structure. Your living situation is the foundation of stability in your life, so when your housing is unstable all aspects of your life are affected.

What We Know… Housing and Health Housing as a social determinant of health has three intersecting constructs: Adequate Housing Conditions: Inadequate housing conditions are associated with both physical and mental illnesses through direct and indirect pathways. Affordability: Affordability (e.g., fear of eviction, housing costs, overcrowding) and stability, defined as frequent moves or in its most extreme form, homelessness, may indirectly impact health. Residential Stability: Structural features of the home (e.g., mold, pest infestation, peeling paint, drafts and energy inefficiencies, physical crowding) directly impact health.

Health Equity In Housing Health equity in housing entails opportunities for all individuals, regardless of race/ethnicity, socioeconomic status, household composition or zip code, to benefit from developments in modern building science, fair maintenance practices. Health equity can best be achieved by focusing on three domains of housing: Encouraging the physical design and layout of residential space to promote health Preserving, improving and better connecting existing affordable housing options Expanding supportive housing options

Community Resources: Social Determinants of Health Whether it’s access to food, transportation, financial services or education, addressing social determinants is a critical component of both quality of care and quality of life. Aunt Bertha is deploying this comprehensive approach, powered by technology, to help lead the way for patients in need and the people who serve them. https://www.auntbertha.com/

Learning In Action: “Food For Thought” How might having data on patient housing/neighborhood environment insecurity affect how your office provides care? Do you know the difference between homelessness and housing insecurity? Do you think that housing insecurity is a common among your patients? Think of a recent patient case in which housing insecurity may have contributed to a problem or a poor health outcome? What resources might be available in your community to help address patients with housing insecurity issues? How might your practice be more efficient and effective in connecting patients with identified housing insecurity issues to community resources?

Questions? Uchenna Okoli SDoH@hcdi.com 301-552-8803 www.hcdi.com For more information on TCPI SANs please use this link: http://www.tcpisan.org/ 11

Learning & Action Network Acronym Guide: AAPM: Advanced Alternative Payment Models APM: Alternative Payment Models CEHRT: Certified Electronic Health Record Technology CFYH Tool: ‘Caring for Your Health’ Social Determinants Indicator Tool CMS: Centers for Medicare & Medicaid Services HCDI: HealthCare Dynamics International LAN: Learning and Action Network MACRA: Medicare Access and CHIP Reauthorization Act MIPS: Merit Based Incentive Payment System PTN: Practice Transformation Network QPP: Quality Payment Program REaL Data: Race Ethnicity and Language Data SAN: Support and Alignment Network SDoH: Social Determinants of Health TCPI: Transforming Clinical Practices Initiative