[section class="social-determinants-of-health-section"] [row class="social-determinants-of-health-row"] [col span__sm="12" class="social-determinants-of-health-outer"] [ux_text font_size__sm="0.85"] [/ux_text] [row_inner class="social-determinants-of-health"] [col_inner span__sm="12"] [row_inner_1 class="sdh highlighted incarcerated_criminal_justice substance_use harm_reduction"] [col_inner_1 span="1" span__sm="1" align="center" bg_color="rgb(252, 179, 43)" color="light" class="short-form new-height"] [title style="center" text="1"] [/col_inner_1] [col_inner_1 span="11" span__sm="11" class="black recommendation-col"]

Fully legalize the possession of both syringes and all non- injection drug use equipment and ensure that any drug residue found on any syringe or non-syringe injection equipment, regardless of the syringe or equipment’s origin, be excluded from qualifying as criminal possession of a controlled substance.

[read_more id="35" more="Section 220.45 of the NY Penal Law establishes a class A..." less="Read less"]
Section 220.45 of the NY Penal Law establishes a class A misdemeanor for possession of a syringe outside the bounds of participation in a licensed SEP or Expanded Syringe Access Program (ESAP). In practice, it is often impossible for SEP or ESAP participants to prove the origins of a syringe acquired lawfully. The law carries risk of arbitrary police and prosecutorial enforcement, discourages SEP participants from accessing their only safe and legal means to sterile drug use equipment, and prevents secondary distribution of sterile syringes to those individuals who cannot access SEPs or ESAPs. The more sterile syringes that are obtained by PWID, the greater the public health benefits become. This section of law should be repealed. Further, non-syringe injection equipment, including cotton filters and “cookers” used to prepare drug solution, are known to transmit HCV. These are considered drug paraphernalia under section 850 of the General Business Law. References to all injection equipment as defined in the General Business Law should be repealed. Furthermore, while section 220.03 of the Penal Law allows for possession of a residual amount of a controlled substance when discovered in a used syringe obtained from a SEP or ESAP provider, no such waiver exists for other injection paraphernalia. Section 220.03 of the Penal Law should be amended to waive criminal liability for possession of drug residue on any used injection equipment.

The criminalization of syringes is also a public health and safety concern for law enforcement personnel. One in three officers reported being stuck by a syringe during their career. Allowing access to syringes has been shown not only to reduce needlestick injuries to law enforcement and to curb the spread of blood borne disease but has even proven to reduce crime and drug use in areas where such laws have been enacted. In the event that a needlestick injury does occur, robust and legal syringe access helps to make it far less likely that a syringe will be infectious.[/read_more]

[/col_inner_1] [/row_inner_1] [row_inner_1 class="sdh highlighted harm_reduction"] [col_inner_1 span="1" span__sm="1" align="center" bg_color="rgb(252, 179, 43)" color="light" class="short-form new-height"] [title style="center" text="2"] [/col_inner_1] [col_inner_1 span="11" span__sm="11" class="black recommendation-col"]

Revise the ESAP to eliminate the 10-syringe cap and lift advertising and other unnecessary restrictions of the ESAP.

[read_more id="36" more="Established in 2001 and overseen by the NYSDOH..." less="Read less"]Established in 2001 and overseen by the NYSDOH, the 2,500 NYS pharmacies participating in the ESAP provide vital access to sterile syringes, especially in rural locations where SEPs are rare or nonexistent. Current public health law prevents ESAP providers from selling more than 10 syringes per transaction, prohibits the programs from advertising syringe availability, and often enforces unnecessary “safety” procedures with each transaction. Removing these barriers will improve syringe access, save lives, save money, and serve as a simple step toward significantly reducing the harms of injection drug use. Eliminating the cap on syringe purchases at ESAPs would improve the likelihood that someone would use a new syringe with each injection. It would also support secondary distribution to other PWID who are not able to access the ESAP. Allowing ESAPs to advertise would create pathways to public health education and reach individuals who may be completely unaware of safer drug use options in their area.[/read_more]

[/col_inner_1] [/row_inner_1] [row_inner_1 class="sdh highlighted HCV_testing incarcerated_criminal_justice HCV_treatment"] [col_inner_1 span="1" span__sm="1" align="center" bg_color="rgb(252, 179, 43)" color="light" class="short-form new-height"] [title style="center" text="3"] [/col_inner_1] [col_inner_1 span="11" span__sm="11" class="black recommendation-col"]

All jails and prisons in NYS should implement opt-out HCV testing. Chronically infected individuals who are on direct-acting antivirals (DAAs) at the time of their admission to jail or whose jail sentence is sufficiently long to complete treatment should be treated. Chronically infected state inmates should all be offered treatment.

[read_more id="37" more="Given the high rates of HCV seroprevalence in the US incarcerated population..." less="Read less"]
Given the high rates of HCV seroprevalence in the US incarcerated population, it is estimated that approximately 30% of all persons with HCV infection in the US spend at least part of the year in a correctional institution. The AASLD/IDSA HCV Guidance Report recommends opt-out HCV testing in correctional settings. The US Preventive Services Task Force and the WHO also recommend that all incarcerated persons be tested for HCV.

In jails in NYS, the median length of stay is 15 days, making on-site treatment not feasible for many inmates. Therefore, NYS should prioritize testing and linkage to medical care in the community upon release from incarceration, as has been implemented in jails in other states. For inmates who will be staying in jail long enough to complete HCV treatment, treatment should be offered, as has been piloted successfully in the NYC jails. Given the associated costs, novel mechanisms for funding must be considered.

It has been the policy of the NYSDOCCS, since 2018, to screen all incoming inmates for HCV. It is the intention of NYSDOCCS to test the entire prison population for HCV. It is NYSDOCCS’ current policy to consider treatment for any chronically infected person regardless of the patient’s level of liver fibrosis. All DOCCS inmates must be offered treatment and care for chronic HCV that adheres to AASLD/IDSA guidelines.[/read_more]

[/col_inner_1] [/row_inner_1] [row_inner_1 class="sdh highlighted HCV_treatment HCV_testing substance_use_treatment harm_reduction insurance"] [col_inner_1 span="1" span__sm="1" align="center" bg_color="rgb(252, 179, 43)" color="light" class="short-form new-height"] [title style="center" text="4"] [/col_inner_1] [col_inner_1 span="11" span__sm="11" class="black recommendation-col"]

Improve access to health care, including both MAT and HCV treatment at SEPs.

[read_more id="38" more="SEPs should focus on efforts to provide both general medical..." less="Read less"]SEPs should focus on efforts to provide both general medical services for PWUD and HCV testing and treatment. Harm reduction programs successfully engage the most at-risk PWUD, and co-located health services would allow the highest risk PWUD, who might not otherwise access any health care, the ability to immediately connect to care. Clinical care should be coordinated and co-located with services that address basic needs including food, housing, counseling and advocacy, access to safe injection equipment and harm reduction education, as well as social support. For marginalized populations living in precarious circumstances, such services are essential to establishing the stability that allows them to take care of their health. Providing basic health care services such as access to MAT, including buprenorphine, in non-traditional settings such as syringe exchange and other harm reduction programs would help expand access to MAT, in turn helping to reduce the use of injection drugs and reduce the risk of HCV infection and transmission.

Most of these non-traditional settings cannot provide co-located medical services due to burdensome administrative processes, including the Certificate of Need process. This limits access to essential health care services for vulnerable populations and creates a barrier for organizations to seek reimbursement through billing mechanisms. The AIDS Institute should work with the NYSDOH Office of Primary Care and Health Systems Management to facilitate the review of Certificate of Need, Article 28 establishment and extension clinic applications to facilitate the delivery of basic medical services to PWUD in non-traditional settings such as SEPs and shelters. Given the crisis nature of the opioid epidemic and the impact on public health, including increased rates of HCV transmission, the NYSDOH should consider whether waivers of existing regulatory requirements could be implemented in order to allow for expedited licensing so that these non-traditional settings (both facility and mobile based) can provide, and be reimbursed for, limited medical services, including MAT.[/read_more]

[/col_inner_1] [/row_inner_1] [row_inner_1 class="sdh highlighted incarcerated_criminal_justice HCV_treatment"] [col_inner_1 span="1" span__sm="1" align="center" bg_color="rgb(252, 179, 43)" color="light" class="short-form new-height"] [title style="center" text="5"] [/col_inner_1] [col_inner_1 span="11" span__sm="11" class="black recommendation-col"]

Continuity of HCV care between jails, prisons, and the surrounding community should be supported by a multidisciplinary team of patient navigators, discharge planners, and health care providers.

[read_more id="39" more="While someone is incarcerated, transitions between correctional facilities and..." less="Read less"]While someone is incarcerated, transitions between correctional facilities and the community are common and impact the continuity of HCV care. Following arrest, individuals are held pre-trial in local jails. If sentenced, they may be transferred to state prison. At several points in this trajectory, return to the community is possible. Such transitions are often associated with disruptions in continuity of care. This is particularly true for individuals returning to the community after incarceration due to competing priorities that range from social to structural. Multidisciplinary care teams consisting of patient navigators, discharge planners, and health care providers should be in place to keep track of individuals who are at various stages of the HCV care cascade in the criminal justice system.

These efforts should be supported by EHRs where available and patient flow charts (such as excel spreadsheets) to minimize losses to follow up. At intake, screening should be performed to assess whether an individual is already on treatment and, if so, it should be continued. Additionally, length of stay should be evaluated prior to treatment initiation to minimize treatment interruption. If direct acting antiviral (DAA) therapy can be delivered prior to release or transfer, data show corrections-based HCV treatment is equivalent to community-based treatment. For individuals who will be transferred to prison, continuity should be maintained through medical hold or effective ‘hand-off’ to the receiving facility.

For those who are pending release prior to treatment completion, efforts should be made to provide take-home or carry medication to minimize treatment interruption upon return to the community. For those who have not been initiated on treatment, a discharge planning team should meet with the patient prior to release to assess community reentry needs and identify a clinic where that individual can be treated. Re-activation of health insurance including Medicaid 30 days prior to reentry should be facilitated by a discharge planner. Efforts should be made to confirm sustained virologic response either in the correctional facility or upon return to the community. Regardless of the transition in care, a summary of medical status should be provided to the patient to maximize continuity of care.[/read_more]

[/col_inner_1] [/row_inner_1] [row_inner_1 class="sdh highlighted substance_use harm_reduction"] [col_inner_1 span="1" span__sm="1" align="center" bg_color="rgb(252, 179, 43)" color="light" class="short-form new-height"] [title style="center" text="6"] [/col_inner_1] [col_inner_1 span="11" span__sm="11" class="black recommendation-col"]

Support evolution of NYS Office of Addiction Services and Supports (OASAS) policy away from an abstinence-only service model.

[read_more id="40" more="While NYS OASAS has traditionally promoted an abstinence-based..." less="Read less"]While NYS OASAS has traditionally promoted an abstinence-based service model, the recently proposed changes to the NYS OASAS regulations setting out service standards for the delivery of Chemical Dependence Services incorporate and promote evidence-based harm reduction and patient-centered approaches. This is a significant change in the focus of the delivery of NYS OASAS services. These proposed changes shift program goals and practices away from abstinence-only service models to include and promote the use of harm reduction principles and approaches in the delivery of NYS OASAS services. Included is the change in language describing program goals from “abstinence” only to “recovery” and achieving patient-centered goals. While there are still areas for clarification in the proposed regulations, the shift from abstinence only to incorporating a harm reduction approach is a positive development. In addition, NYS OASAS developed and disseminated to NYS OASAS-certified providers a new Patient-Centered Care Guidance document. As one of its principles, this guidance recognizes that person-centered treatment planning includes working with people whose treatment goal may be something other than abstinence, including reducing use and minimizing risk associated with the individual’s substance use pattern.[/read_more]

[/col_inner_1] [/row_inner_1] [row_inner_1 class="sdh highlighted substance_use mental_health MSM LGBTQ_communities HIV training_education"] [col_inner_1 span="1" span__sm="1" align="center" bg_color="rgb(252, 179, 43)" color="light" class="short-form new-height"] [title style="center" text="7"] [/col_inner_1] [col_inner_1 span="11" span__sm="11" class="black recommendation-col"]

Focus efforts on key target populations who the health care system has historically not engaged.

[read_more id="41" more="A change in the demographics of populations impacted..." less="Read less"]A change in the demographics of populations impacted by HCV has coincided with multiple changes in public policy in NYS, reframing substance use disorder as a public health issue rather than a criminal justice issue. While these sensible policy changes should be celebrated, there must be recognition that these changes only arrived once affluent white communities were hit with an opioid and overdose epidemic. Such a response has given communities of color, low-income communities, and LGBTQ communities the sense that their suffering from harms associated with drug use did not warrant such a response. This experience, and the mistrust, anger, insult, and sorrow these communities feel in the broader context of historic public health policy that has not always been kind to them must be acknowledged, validated, and studied or HCV policy may be unable to reach these communities.

PWUD, people in recovery, people with mental illness, MSM, transgender people and women of color all suffer disproportionately from chronic HCV. The diversity of these groups makes it hard to target all communities at risk with a single message. Partnerships are recommended with the many community groups that represent and serve the needs of communities with the highest HCV prevalence to gain their trust. It is important to work with groups that engage and represent young PWUD, MSM at risk for and living with HIV, and transgender women. These community-based groups must play a critical role in developing and leading educational campaigns, in partnership with government entities. Educational materials must address HCV prevention, testing, and treatment as well as other related health issues. Campaigns and materials must be culturally appropriate and available in English, Spanish, and other languages as appropriate. Training of medical providers across specialty areas on culturally and linguistically sensitive care for PWUD, MSM, and transgender individuals is recommended. The principles of trauma-informed care must be included in all trainings. Health care providers who already provide services to the highest risk groups and vulnerable populations (i.e., HIV providers, substance use providers, providers serving the LGBTQ community) should be targeted for training to improve their capacity to offer HCV-related services.[/read_more]

[/col_inner_1] [/row_inner_1] [row_inner_1 class="sdh highlighted housing_homelessness insurance HCV_treatment harm_reduction"] [col_inner_1 span="1" span__sm="1" align="center" bg_color="rgb(252, 179, 43)" color="light" class="short-form new-height"] [title style="center" text="8"] [/col_inner_1] [col_inner_1 span="11" span__sm="11" class="black recommendation-col"]

Address barriers to transportation, housing instability and employment among people living with HCV.

[read_more id="42" more="Transportation barriers to health care access are…" less="Read less"]Transportation barriers to health care access are common and greater for vulnerable populations. These impact not only access to provider appointments but also access to pharmacies and medication adherence. Access to transportation was one of the barriers most commonly identified across NYS in the 2016 HCV listening sessions hosted by VOCAL-NY. Dedicated funding is needed for transportation to and from medical appointments for patients with chronic HCV who are covered through Medicaid. In many areas of the state, people must travel great distances to see a provider able to treat HCV. The implementation of mobile medical units that could travel to different areas of the state and bring HCV care to areas that are currently underserved should be explored.

The 2016 NYC HCV Elimination Gaps Analysis found that 61% of respondents reported housing instability prevented patients from getting HCV treatment. Non-engaged patients are significantly more likely to be homeless than patients engaged in care. Studies find that health care providers identify housing instability as a barrier to HCV treatment and prescribe DAAs less frequently to homeless patients. Several approaches to improving HCV treatment uptake among unstably housed New Yorkers are proposed. Resources from the existing NYS Medicaid Redesign Team Supportive Housing Initiative could be specifically allocated for housing for people living with HCV. A medical respite model, in which people who are unstably housed are given temporary supportive housing while undergoing medical treatment, should be considered. It has been shown to provide a cost-effective model for treating homeless people requiring long-term IV antibiotic treatment and could readily be adapted for HCV treatment. We suggest that NYS consider funding to study such a program. Novel models of safe medication storage and adherence support should be considered for patients who are marginally housed. Safe storage of HCV medications should be made available for all patients residing in the shelter system. Medications can also be stored and administered at other sites where people who are homeless receive services, such as SEPs.

Employment assistance programs should be available to persons living with HCV. Where we work influences our health, not only by exposing us to physical conditions that have health effects, but also by providing a setting where healthy activities and behaviors can be promoted. Work can provide a sense of identity, social status and purpose in life, as well as social support. For most Americans, employment is the primary source of income, giving them the means to live in homes and neighborhoods that promote health and to pursue health-promoting behaviors. In addition, most Americans obtain their health care insurance through their jobs. Not only does work affect health; health also affects work. Good health is often needed for employment, particularly for low-skilled workers. Lack of employment among those who are unable to work because of ill health can lead to further economic and social disadvantage and fewer resources and opportunities to improve health.[/read_more]

[/col_inner_1] [/row_inner_1] [row_inner_1 class="sdh highlighted incarcerated_criminal_justice harm_reduction substance_use substance_use_treatment"] [col_inner_1 span="1" span__sm="1" align="center" bg_color="rgb(252, 179, 43)" color="light" class="short-form new-height"] [title style="center" text="9"] [/col_inner_1] [col_inner_1 span="11" span__sm="11" class="black recommendation-col"]

Drug court personnel must be trained in evidence-based treatment for OUD and principles of harm reduction.

[read_more id="43" more="Training for drug court personnel, including judges..." less="Read less"]Training for drug court personnel, including judges, prosecutors, defense attorneys, parole officers, and other court employees, must facilitate the understanding that OUD is a chronic relapsing medical condition, rather than a moral failing. Relapse must be dealt with as an expected complication of OUD rather than a “violation” warranting punishment. The threat of incarceration should not be used to force a person to receive OUD treatment. Harm reduction seeks to provide low threshold non-judgmental services to people who use drugs and prevent the harms associated with drug use. Such services do not require abstinence and can be a gateway to OUD and HCV treatment. Its principles should be adapted when providing such treatment to people who are in contact with the criminal justice system. OUD treatment modalities should be neither unnecessarily withheld, nor coerced, especially in drug court. Treatment must be patient led. Drug court personnel must receive training in the principles of MAT (i.e., methadone, buprenorphine, naltrexone) and be made aware of the evidence proving the efficacy of this approach in reducing drug use, recidivism, overdose, and HCV and HIV transmission.[/read_more]

[/col_inner_1] [/row_inner_1] [row_inner_1 class="sdh highlighted incarcerated_criminal_justice harm_reduction substance_use insurance"] [col_inner_1 span="1" span__sm="1" align="center" bg_color="rgb(252, 179, 43)" color="light" class="short-form new-height"] [title style="center" text="10"] [/col_inner_1] [col_inner_1 span="11" span__sm="11" class="black recommendation-col"]

Support criminal justice diversion programs for PWUD.

[read_more id="44" more="NYS jurisdictions should move to adopt programs to divert individuals..." less="Read less"]NYS jurisdictions should move to adopt programs to divert individuals from the criminal justice system for low-level drug possession into harm reduction-based care services such as syringe exchange programs. One such program is the Law Enforcement Assisted Diversion (LEAD) program that was piloted in Albany using resources that were available through the Medicaid Redesign initiative. This initiative formalizes relationships among harm reduction agencies and law enforcement, representing a public safety-public health collaboration. LEAD is a holistic approach initiated by law enforcement and involving the broader community in a patient-centered, trauma-informed approach to care and services for PWUD. The LEAD model facilitates partnerships among often disparate entities, including law enforcement, the criminal justice system, harm reduction and social service providers, medical institutions, faith-based communities and behavioral health care systems.

Data from LEAD Albany is still being evaluated. However, evaluation studies of other LEAD programs, such as the one in Seattle, have more published evidence supporting their approaches and show a positive impact on recidivism, housing and other benefits for PWUD. The Social Determinants of Health Workgroup endorses the recommendation of the NYSDOH AIDS Institute Drug User Health Advisory Group to establish a committee to assess the feasibility and determine implementation strategies for a scale-out of LEAD programs statewide. NYS should also identify and evaluate other similar models.[/read_more]

[/col_inner_1] [/row_inner_1] [row_inner_1 class="sdh highlighted substance_use HCV_treatment insurance"] [col_inner_1 span="1" span__sm="1" align="center" bg_color="rgb(252, 179, 43)" color="light" class="short-form new-height"] [title style="center" text="11"] [/col_inner_1] [col_inner_1 span="11" span__sm="11" class="black recommendation-col"]

Promote the use of incentives to improve HCV care engagement among PWUD.

[read_more id="45" more="Successful models already exist for the use of incentives..." less="Read less"]Successful models already exist for the use of incentives to reduce HIV transmission by achieving and maintaining an undetectable viral load. Housing Works launched its “Undetectables” program in March 2014.The program has since been expanded to other community-based organizations through funding from the AIDS Institute. Recently, a similar program was launched by Amida Care, a special needs Medicaid managed care plan, to incentivize its members to achieve and maintain viral load suppression. These models can be adapted for use in HCV treatment and adherence. Many HCV providers and patients have numerous competing priorities, including other chronic conditions, unmet subsistence needs and behavioral health issues. The use of incentives for HCV treatment engagement and adherence helps to keep attention on achieving the key goals of engagement in HCV treatment and achieving a cure. For providers, including Medicaid managed care plans and health homes, incentivization could be built into the reimbursement structure. For patients, incentives such as gift cards or non-cash rewards could be provided for initiating treatment, keeping appointments, adherence milestones, achieving an undetectable viral load, and sustained virologic response. New computer-based and social-media technologies may present opportunities for monitoring and encouraging HCV treatment in ways that were not previously possible.[/read_more]

[/col_inner_1] [/row_inner_1] [row_inner_1 class="sdh highlighted HCV_treatment housing_homelessness insurance"] [col_inner_1 span="1" span__sm="1" align="center" bg_color="rgb(252, 179, 43)" color="light" class="short-form new-height"] [title style="center" text="12"] [/col_inner_1] [col_inner_1 span="11" span__sm="11" class="black recommendation-col"]

Expand access to Medicaid Health Homes for people with HCV mono-infection.

[read_more id="46" more="In order to effectively address the structural barriers..." less="Read less"]In order to effectively address the structural barriers to HCV treatment, referrals to the full range of existing care coordination systems to meet the non-medical needs of low-income people with HCV are critical. For Medicaid enrollees, the framework for this care coordination system already exists in NYS in the form of the Health Home program. While persons who are HCV positive and have another co-occurring chronic condition are eligible for Health Home care coordination services, many HCV mono-infected individuals are currently ineligible. It is just as critical for a person mono-infected with HCV to access care and treatment early before liver damage and the other consequences of HCV infection occur as it is for a person who has HCV and another chronic condition. The eligibility criteria for Health Home Services should be expanded to include HCV diagnosis as a unique qualifier to leverage the existing care coordination framework of Health Homes to more effectively link the HCV mono-infected population to housing programs and other support services addressing social determinants of health.[/read_more]

[/col_inner_1] [/row_inner_1] [row_inner_1 class="sdh highlighted stigma substance_use harm_reduction training_education"] [col_inner_1 span="1" span__sm="1" align="center" bg_color="rgb(252, 179, 43)" color="light" class="short-form new-height"] [title style="center" text="13"] [/col_inner_1] [col_inner_1 span="11" span__sm="11" class="black recommendation-col"]

Promote training to destigmatize drug use and people who use drugs (PWUD).

[read_more id="47" more="Most new HCV infections occur in PWUD..." less="Read less"]Most new HCV infections occur in PWUD, a highly stigmatized population. This stigma can be a barrier to a wide range of opportunities and rights. NYS should promote “person-first” language to describe PWUD; for example, “person with a substance use disorder” rather than “addict.” All internal and public communications from state agencies should use appropriate, person-centered language when referring to drug use and the people who use them. Using the glossary developed by the Drug Policy Alliance as a guide, trainings on the use of person-centered language and principles of harm reduction should be developed for all professionals who work with PWUD.

Health care workers, law enforcement officers, and EMS workers should also be provided with education on harm reduction and on providing stigma-free services to PWUD. NYS should require continuing education credits focused on the harm reduction approach to working with PWUD for any professional who contributes to behavioral health counseling, pharmacists, and medical personnel. In addition, stigma-free, harm reduction-focused approaches to working with PWUD should be added to the curriculum in all university settings for medical students, residents, counselors, and social workers. This can be done by developing programs to foster collaborations between harm reduction agencies and educational institutions to promote and develop culturally competent harm reduction educational opportunities.[/read_more]

[/col_inner_1] [/row_inner_1] [row_inner_1 class="sdh highlighted housing_homelessness training_education insurance"] [col_inner_1 span="1" span__sm="1" align="center" bg_color="rgb(252, 179, 43)" color="light" class="short-form new-height"] [title style="center" text="14"] [/col_inner_1] [col_inner_1 span="11" span__sm="11" class="black recommendation-col"]

Collect data on social determinants of health among people living with HCV and assist agencies with their ability to assess social determinants of health.

[read_more id="48" more="New York State has taken a leadership role..." less="Read less"]New York State has taken a leadership role in addressing social determinants of health (SDH). The NYS Medicaid Redesign Program recognizes housing, education, poverty, and nutrition as drivers of medical utilization, cost, and health outcomes. Also, in January 2018, the NYS DOH established the Bureau of Social Determinants of Health within the Office of Health Insurance Programs to address SDH in NYS. To assist in identifying the barriers to care and health disparities, indicators of the major SDH—such as housing instability, economic status, job status, food insecurity, and availability of transportation—should be added as indicators to electronic health records. In conjunction with Medicaid Redesign, the value-based payment roadmap, and the BSDH, New York has already created a framework for organizations to incorporate social determinants of health into their practices.

However, health care and social services agencies still face challenges in integrating this information in their practices and programs. Resources in the form of technical assistance, provider tools and funding should be provided to agencies to assist with these steps.

In addition, to scale the data collection and distribution for analysis within health care settings and for action within non-health care settings, other steps should be taken including: using standardized code systems to represent social determinants, developing a standard assessment tool to standardize data collection, and developing and sharing best practices for methods of collection, distribution and usage of the data. Existing frameworks, such as leveraging the Statewide Health Information Network-New York (SHIN-NY) for community-based organizations and expanding SHIN-NY to exchange non-clinical data points for social determinants of health, should be employed in the scale-up of data collection.[/read_more]

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