The ongoing COVID-19 pandemic has placed a spotlight on the social determinants of health (SDOH) - generally defined as health access and quality, education, economic circumstances, food security, social conditions and environmental factors. It is estimated SDOH determine as much as 60% of one's health status, whereas formal medical care accounts for just 10%. Concerning economic circumstances, forty years of wage stagnation among lower income workers has left 45% of Americans with either no health care insurance or insurance with out of pocket expenses so high they avoid seeking care when, for example, they develop COVID-related symptoms. Federal health care policymakers, providers and insurers have however slowly begun to take interest in addressing SDOH as a way to improve health care outcomes and costs. For example, Medicare Advantage (MA) plans, which enroll more than one-third of all Medicare beneficiaries, have recently been given regulatory authority to offer MA beneficiaries supplemental benefits beyond medical care such as meal delivery, home modifications and personal care services. Recently as well, the 2017 tax bill contained a provision that created Opportunity Zones (OZs) designed to attract long term investment via tax incentives to address social and economic realities in high poverty communities.
During this 32 minute conversation, Mr. Gorman provides an overview of his investment firm, Nightingale Partners, explains the OZ provision in the 2017 tax law and moreover details how OZ investments can be and are being used to address social determinants of health including housing, food security, transportation and the use of community health workers. He also explains how providers and plans can exploit OZ legislation and the extent to which MA plans are making use of recent supplemental benefit regulatory reform.
Mr. John Gorman is the Founder and former Executive Chairman of Gorman Health Group. Previously, Mr. Gorman served as Assistant to the Director of Health Care Financing Administration’s (HCFA, now CMS) Office of Managed Care. During the 1993 debate on national health care reform, Mr. Gorman served as chief lobbyist on health care financing issues for the National Association of Community Health Centers. Mr. Gorman's career in Washington began as Press Secretary and Staff Director for Congressional Representative John Conyers, Jr. (D-MI), then Chairman of the Government Operations Committee. Mr. Gorman currently serves on the Board of Directors of Henry Ford Health System’s Health Alliance Plan in his home town of Detroit and serves as a Senior Advisor to Premier, Inc., a hospital purchasing cooperative.
The CDC's SDOH website is at: https://www.cdc.gov/socialdeterminants/index.htm
Information on Nightingale Partners is at: https://www.nightingalepartners.org/
Information on OZ's is at: https://www.irs.gov/credits-deductions/opportunity-zones-frequently-asked-questions
John Gorman Discusses the Use of Opportunity Zones to Address Social Determinants (October 21st)