[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]




 
   EMPOWERED BY DATA: LEGISLATION TO ADVANCE EQUITY AND PUBLIC HEALTH

=======================================================================

                             HYBRID HEARING

                               BEFORE THE

                         SUBCOMMITTEE ON HEALTH

                                 OF THE

                    COMMITTEE ON ENERGY AND COMMERCE
                        HOUSE OF REPRESENTATIVES

                    ONE HUNDRED SEVENTEENTH CONGRESS

                             FIRST SESSION

                               __________

                             JUNE 24, 2021

                               __________

                           Serial No. 117-39


     Published for the use of the Committee on Energy and Commerce

                   govinfo.gov/committee/house-energy
                        energycommerce.house.gov
                        
                        
                        
                      ______

             U.S. GOVERNMENT PUBLISHING OFFICE 
 51-212                WASHINGTON : 2023                       
                        
                        
                        
                        
                        
                    COMMITTEE ON ENERGY AND COMMERCE

                     FRANK PALLONE, Jr., New Jersey
                                 Chairman
BOBBY L. RUSH, Illinois              CATHY McMORRIS RODGERS, Washington
ANNA G. ESHOO, California              Ranking Member
DIANA DeGETTE, Colorado              FRED UPTON, Michigan
MIKE DOYLE, Pennsylvania             MICHAEL C. BURGESS, Texas
JAN SCHAKOWSKY, Illinois             STEVE SCALISE, Louisiana
G. K. BUTTERFIELD, North Carolina    ROBERT E. LATTA, Ohio
DORIS O. MATSUI, California          BRETT GUTHRIE, Kentucky
KATHY CASTOR, Florida                DAVID B. McKINLEY, West Virginia
JOHN P. SARBANES, Maryland           ADAM KINZINGER, Illinois
JERRY McNERNEY, California           H. MORGAN GRIFFITH, Virginia
PETER WELCH, Vermont                 GUS M. BILIRAKIS, Florida
PAUL TONKO, New York                 BILL JOHNSON, Ohio
YVETTE D. CLARKE, New York           BILLY LONG, Missouri
KURT SCHRADER, Oregon                LARRY BUCSHON, Indiana
TONY CARDENAS, California            MARKWAYNE MULLIN, Oklahoma
RAUL RUIZ, California                RICHARD HUDSON, North Carolina
SCOTT H. PETERS, California          TIM WALBERG, Michigan
DEBBIE DINGELL, Michigan             EARL L. ``BUDDY'' CARTER, Georgia
MARC A. VEASEY, Texas                JEFF DUNCAN, South Carolina
ANN M. KUSTER, New Hampshire         GARY J. PALMER, Alabama
ROBIN L. KELLY, Illinois, Vice       NEAL P. DUNN, Florida
    Chair                            JOHN R. CURTIS, Utah
NANETTE DIAZ BARRAGAN, California    DEBBBIE LESKO, Arizona
A. DONALD McEACHIN, Virginia         GREG PENCE, Indiana
LISA BLUNT ROCHESTER, Delaware       DAN CRENSHAW, Texas
DARREN SOTO, Florida                 JOHN JOYCE, Pennsylvania
TOM O'HALLERAN, Arizona              KELLY ARMSTRONG, North Dakota
KATHLEEN M. RICE, New York
ANGIE CRAIG, Minnesota
KIM SCHRIER, Washington
LORI TRAHAN, Massachusetts
LIZZIE FLETCHER, Texas
                                 ------                                

                           Professional Staff

                   JEFFREY C. CARROLL, Staff Director
                TIFFANY GUARASCIO, Deputy Staff Director
                  NATE HODSON, Minority Staff Director
                         Subcommittee on Health

                       ANNA G. ESHOO, California
                                Chairwoman
G. K. BUTTERFIELD, North Carolina    BRETT GUTHRIE, Kentucky
DORIS O. MATSUI, California            Ranking Member
KATHY CASTOR, Florida                FRED UPTON, Michigan
JOHN P. SARBANES, Maryland, Vice     MICHAEL C. BURGESS, Texas
    Chair                            H. MORGAN GRIFFITH, Virginia
PETER WELCH, Vermont                 GUS M. BILIRAKIS, Florida
KURT SCHRADER, Oregon                BILLY LONG, Missouri
TONY CARDENAS, California            LARRY BUCSHON, Indiana
RAUL RUIZ, California                MARKWAYNE MULLIN, Oklahoma
DEBBIE DINGELL, Michigan             RICHARD HUDSON, North Carolina
ANN M. KUSTER, New Hampshire         EARL L. ``BUDDY'' CARTER, Georgia
ROBIN L. KELLY, Illinois             NEAL P. DUNN, Florida
NANETTE DIAZ BARRAGAN, California    JOHN R. CURTIS, Utah
LISA BLUNT ROCHESTER, Delaware       DAN CRENSHAW, Texas
ANGIE CRAIG, Minnesota               JOHN JOYCE, Pennsylvania
KIM SCHRIER, Washington              CATHY McMORRIS RODGERS, Washington 
LORI TRAHAN, Massachusetts               (ex officio)
LIZZIE FLETCHER, Texas
FRANK PALLONE, Jr., New Jersey (ex 
    officio)
                             C O N T E N T S

                              ----------                              
                                                                   Page
Hon. Anna G. Eshoo, a Representative in Congress from the State 
  of California, opening statement...............................     2
    Prepared statement...........................................     3
Hon. Brett Guthrie, a Representative in Congress from the 
  Commonwealth of Kentucky, opening statement....................     4
    Prepared statement...........................................     6
Hon. Frank Pallone, Jr., a Representative in Congress from the 
  State of New Jersey, opening statement.........................     7
    Prepared statement...........................................     8
Hon. Cathy McMorris Rodgers, a Representative in Congress from 
  the State of Washington, opening statement.....................     9
    Prepared statement...........................................    11
Hon. Richard Hudson, a Representative in Congress from the State 
  of North Carolina, prepared statement..........................   109

                               Witnesses

Karen B. DeSalvo, M.D., Chief Health Officer, Google Health......    13
    Prepared statement...........................................    15
    Answers to submitted questions...............................   232
Romilla Batra, M.D., Chief Medical Officer, SCAN Health Plan.....    25
    Prepared statement...........................................    27
    Answers to submitted questions...............................   235
Beth I. Blauer, Executive Director, Johns Hopkins University 
  Centers for Civic Impact.......................................    34
    Prepared statement...........................................    36
    Answers to submitted questions...............................   240
Faisel Syed, M.D., National Director of Primary Care, ChenMed....    42
    Prepared statement...........................................    44
    Answers to submitted questions...............................   243
Kara Odom Walker, Executive Vice President and Chief Population 
  Health Officer, Nemours Children's Health System...............    46
    Prepared statement...........................................    48
    Answers to submitted questions...............................   245

                           Submitted Material

H.R. 379, the Improving Social Determinants of Health Act of 
  2021\1\
H.R. 666, the Anti-Racism in Public Health Act of 2021\1\
H.R. 778, the Secure Data and Privacy for Contact Tracing Act of 
  2021\1\
H.R. 791, the Tracking COVID-19 Variants Act\1\
H.R. 831, the Health Standards To Advance Transparency, 
  Integrity, Science, Technology Infrastructure, and Confidential 
  Statistics Act of 2021\1\
H.R. 925, the Data to Save Moms Act\1\
H.R. 943, the Social Determinants for Moms Act\1\
H.R. 976, the Ensuring Transparent Honest Information on COVID-19 
  Act or the ETHIC Act\1\
H.R. 2125, the Quit Because of COVID-19 Act\1\
H.R. 2503, the Social Determinants Accelerator Act of 2021\1\

----------

\1\ The legislation has been retained in committee files and is 
available at https://docs.house.gov/Committee/Calendar/
ByEvent.aspx?EventID=112817.
H.R. 3894, the Collecting and Analyzing Resources Integral and 
  Necessary for Guidance for Social Determinants of Health Act of 
  2021\1\
H.R. 3969, a bill to amend title XXVII of the Public Health 
  Service Act\1\
H.R. 4026, a bill to require the Comptroller General of the 
  United States to submit to Congress a report\1\
Statement of the March of Dimes by Stacey D. Stewart, President 
  and Chief Executive Officer, June 24, 2021, submitted by Ms. 
  Eshoo..........................................................   110
Statement of AHIP, ``Medicare Advantage: Overcoming Barriers to 
  Good Health,'' March 2021, submitted by Ms. Eshoo..............   114
Report by NORC at the University of Chicago, ``Spotlight on 
  Health: Analysis of COVID-19 Impact on Medicare Advantage and 
  Fee-for-Service Beneficiaries,'' May 18, 2021, submitted by Ms. 
  Eshoo..........................................................   115
Letter of June 23, 2021, from Gary L. LeRoy, Board Chair, 
  American Academy of Family Physicians, to Ms. Eshoo and Mr. 
  Guthrie, submitted by Ms. Eshoo................................   125
Letter of June 23, 2021, from Jennifer L. Ellis and Paul L. 
  Underwood, Cochairs, Policy and Advocacy Committee, Association 
  of Black Cardiologists, to Ms. Eshoo and Mr. Guthrie, submitted 
  by Ms. Eshoo...................................................   128
Statement of Aligning for Health, June 24, 2021, submitted by Ms. 
  Eshoo..........................................................   131
Report by Anthem, ``Expanding Access to Care and Social 
  Supports,'' submitted by Ms. Eshoo.............................   134
Report of the Blue Cross Blue Shield Association, ``Social 
  Determinants of Health,'' June 16, 2021, submitted by Ms. Eshoo   138
Report of the Blue Cross Blue Shield Association, ``Improving 
  Black Maternal Care and Health Through Pregnancy and 
  Childbirth,'' submitted by Ms. Eshoo...........................   154
Report on behalf of the Better Medicare Alliance, ``Comparing the 
  Demographics of Enrollees in Medicare Advantage and Fee-For-
  Service Medicare,'' by Milliman, October 2020, submitted by Ms. 
  Eshoo..........................................................   159
Statement of Hon. Ayanna Pressley, a Representative in Congress 
  from the Commonwealth of Massachusetts, June 24, 2021, 
  submitted by Ms. Eshoo.........................................   176
Letter of April 30, 2021, from Representative Val Demings, et 
  al., to Secretary Xavier Becerra, Department of Health and 
  Human Services, submitted by Ms. Eshoo.........................   179
Letter of June 23, 2021, from Harold P. Wimmer, President and 
  Chief Executive Officer, American Lung Association, to Ms. 
  Eshoo and Mr. Guthrie, submitted by Ms. Eshoo..................   181
Statement of the National Indian Health Board, June 24, 2021, 
  submitted by Ms. Eshoo.........................................   185
Statement of Dr. Jim Jirjis, Chief Health Information Officer, 
  HCA Healthcare, June 23, 2021, submitted by Ms. Eshoo..........   194
Letter of June 17, 2021, from Senator Cory A. Booker, et al., to 
  House Speaker Nancy Pelosi and Senate Majority Leader Charles 
  E. Schumer, submitted by Ms. Eshoo.............................   197
H.R. ___, the Addressing Social Determinants in Medicare 
  Advantage Act of 2021, submitted by Ms. Eshoo..................   205
Letter from Sinsi Hernandez-Cancio, Vice President for Health 
  Justice, National Partnership for Women & Families, to Ms. 
  Eshoo and Mr. Guthrie, submitted by Ms. Kelly..................   208
News release of May 14, 2021, ``New Report Ends Corporate Media's 
  Favorite False Narrative About Florida's Successful COVID-19 
  Response,'' Executive Office of Ron DeSantis, Governor of 
  Florida, submitted by Mr. Bilirakis............................   210
Report of the National Partnership for Women & Families and the 
  National Birth Equity Collaborative, ``Saving the Lives of Moms 
  and Babies: Addressing Racism and Socioeconomic Influencers,'' 
  by Joia Creer-Perry and Sinsi Hernandez-Cancio, submitted by 
  Ms. Eshoo......................................................   212

----------

\1\ The legislation has been retained in committee files and is 
available at https://docs.house.gov/Committee/Calendar/
ByEvent.aspx?EventID=112817.
Report of AHIP, ``Social Determinants of Health and Medicare 
  Advantage: Policy Recommendations to Achieve Greater Impact on 
  Reducing Disparities & Advancing Health Equity for America's 
  Medicare Population,'' submitted by Ms. Eshoo..................   218
Statement of J. Nadine Gracia, President and Chief Executive 
  Officer, Trust for America's Health, June 24, 2021, submitted 
  by Ms. Eshoo...................................................   223
Article of June 15, 2021, ``Ending sickle cell disease is a 
  matter of racial justice,'' by Brett P. Giroir, The Hill, 
  submitted by Ms. Eshoo.........................................   228
Letter of June 23, 2021, from Barbara Petee, Executive Director, 
  and Thomas Dorney, Director, The Root Cause Coalition, to Ms. 
  Eshoo and Mr. Guthrie, submitted by Ms. Eshoo..................   231


   EMPOWERED BY DATA: LEGISLATION TO ADVANCE EQUITY AND PUBLIC HEALTH

                              ----------                              


                        THURSDAY, JUNE 24, 2021

                  House of Representatives,
                            Subcommittee on Health,
                          Committee on Energy and Commerce,
                                                    Washington, DC.
    The subcommittee met, pursuant to call, at 10:30 a.m., in 
the John D. Dingell Room 2123, Rayburn House Office Building, 
and remotely via Cisco Webex online video conferencing, Hon. 
Anna G. Eshoo (chairwoman of the subcommittee) presiding.
    Members present: Representatives Eshoo, Matsui, Castor, 
Sarbanes, Welch, Schrader, Cardenas, Ruiz, Dingell, Kuster, 
Kelly, Barragan, Blunt Rochester, Craig, Schrier, Trahan, 
Fletcher, Pallone (ex officio), Guthrie (subcommittee ranking 
member), Upton, Burgess, Griffith, Bilirakis, Long, Bucshon, 
Mullin, Hudson, Carter, Dunn, Curtis, Crenshaw, Joyce, and 
Rodgers (ex officio).
    Staff present: Shana Beavin, Professional Staff Member; 
Jeffrey C. Carroll, Staff Director; Waverly Gordon, General 
Counsel; Tiffany Guarascio, Deputy Staff Director; Perry 
Hamilton, Clerk; Zach Kahan, Deputy Director, Outreach and 
Member Service; Una Lee, Chief Health Counsel; Meghan Mullon, 
Policy Analyst; Joe Orlando, Policy Analyst; Michael Ovlin, 
Health Fellow; Tim Robinson, Chief Counsel; Chloe Rodriguez, 
Clerk; Kylea Rogers, Staff Assistant; Andrew Souvall, Director 
of Communications, Outreach, and Member Services; Kimberlee 
Trzeciak, Chief Health Advisor; Alec Aramanda, Minority 
Professional Staff Member, Health; Sarah Burke, Minority Deputy 
Staff Director; Theresa Gambo, Minority Financial and Office 
Administrator; Seth Gold, Minority Professional Staff Member, 
Health; Grace Graham, Minority Chief Counsel, Health; Nate 
Hodson, Minority Staff Director; Peter Kielty, Minority General 
Counsel; Emily King, Minority Member Services Director; Bijan 
Koohmaraie, Minority Chief Counsel, Oversight and 
Investigations Chief Counsel; Clare Paoletta, Minority Policy 
Analyst, Health; Kristin Seum, Minority Counsel, Health; 
Kristen Shatynski, Minority Professional Staff Member, Health; 
Olivia Shields, Minority Communications Director; Michael 
Taggart, Minority Policy Director; and Everett Winnick, 
Minority Director of Information Technology.
    Ms. Eshoo. The Subcommittee on Health will now come to 
order. And due to COVID-19, today's hearing is being held both 
remotely and in person.
    For Members and witnesses taking part remotely, microphones 
will be set on mute to eliminate background noise. Members and 
witnesses, you will need to unmute your microphone when you 
wish to speak.
    Since Members are participating from different locations at 
today's hearing, recognition of Members for questions will be 
in the order of subcommittee seniority. So keep that in mind.
    The documents for the record should be sent to Meghan 
Mullon at the email address that has been provided to your 
staff. All documents will be entered into the record at the 
conclusion of the hearing.
    The Chair now recognizes herself for 5 minutes for an 
opening statement.

 OPENING STATEMENT OF HON. ANNA G. ESHOO, A REPRESENTATIVE IN 
             CONGRESS FROM THE STATE OF CALIFORNIA

    ``Underfunded and under threat.'' That was the Associated 
Press and Kaiser Health News' indictment of the U.S. public 
health system, based on their award-winning investigation last 
year. The investigation found that, since 2010, spending for 
State public health departments dropped by 16 percent per 
capita, and spending for local health departments fell by 18 
percent. At least 38,000 State and local public health jobs 
have disappeared since the 2008 recession.
    Our hollowed-out public health system explains why we have 
seen COVID-19 cases tracked using fax machines and COVID-19 
vaccines recorded on little white paper cards. These antiquated 
methods are embarrassing for our country that once held a--had 
a globally respected public health system. And our disarrayed 
data collection has brought our--consequences for so many 
Americans. It has allowed racial health disparities to flourish 
without intervention. And as the common maxim goes, you can't 
manage what you can't measure.
    The 13 bills our subcommittee is considering today begin to 
rebuild our public health systems beyond pen-and-paper data 
collection and inconsistent definitions. Several of the bills 
use data to help our health systems improve the overall health 
and wellness of local populations rather than treat individual 
sickness.
    I am proud to colead, with Representative Peters, the 
Health STATISTICS Act, which directs the CDC to develop 
uniform, public health data standards for State and local 
health departments.
    Put simply, public health data is a mess. A striking 
example is the incomplete and inconsistent COVID-19 case counts 
and death tallies, which is addressed by bills authored by 
Representatives Castor, Speier, and Bera.
    Beyond COVID-19, inconsistent public health data have been 
raised repeatedly as an issue before this subcommittee in 
hearings. An example of this is that there is not a single 
standard for how to define a gun death or maternal death. My 
legislation with Representative Peters carries out several 
recommendations from the GAO and the National Academies of 
Science to make vital health statistics electronically 
available and comparable.
    Robust and accessible public health data is a critical tool 
for State and local officials in their efforts to address the 
social determinants of health that perpetuate the inequities in 
our communities. Representative Barragan's Improving Social 
Determinants of Health Act builds and complements the Health 
STATISTICS Act by authorizing a new CDC program that would use 
the improved and available health data to address structural 
challenges, such as unsafe housing, poor transportation, or 
food deserts.
    The remaining bills work together to use public health data 
to address health disparities starting at conception through 
childhood, and into adulthood. I am proud that our subcommittee 
is once again leading the charge in a bipartisan way to promote 
health equity through evidence-based, data-driven policy.
    Taken together, these 13 bills will make real and lasting 
change to rebuild our public health system so we can address 
both new health emergencies, like COVID-19, as well as the 
systemic issues of poverty and inequality.
    [The prepared statement of Ms. Eshoo follows:]

                Prepared Statement of Hon. Anna G. Eshoo

    ``Underfunded and under threat.'' That was the Associated 
Press and Kaiser Health News' indictment of the U.S. public 
health system based on their award-winning investigation last 
year.
    The investigation found that since 2010, spending for state 
public health departments dropped by 16% per capita and 
spending for local health departments fell by 18%. At least 
38,000 state and local public health jobs have disappeared 
since the 2008 recession.
    Our hollowed-out public health system explains why we've 
seen COVID-19 cases tracked using fax machines and COVID-19 
vaccines recorded on white paper cards.
    These antiquated methods are embarrassing for a nation that 
once had a globally respected public health system, and our 
disarrayed data collection has broader consequences for many 
Americans. It has allowed racial health disparities to flourish 
without intervention. As the common maxim goes ``you can't 
manage what you can't measure.''
    The 13 bills our Subcommittee is considering today begin to 
rebuild our public health systems beyond pen-and-paper data 
collection and inconsistent definitions. Several of the bills 
use data to help our health systems improve the overall health 
and wellness of local populations rather than treat individual 
sickness.
    I'm proud to co-lead with Representative Peters, the Health 
STATISTICS Act, which directs the CDC to develop uniform public 
health data standards for state and local health departments.
    Put simply, public health data is a mess. A striking 
example is the incomplete and inconsistent COVID-19 case counts 
and death tallies, which is addressed by bills authored by 
Representatives Castor, Speier, and Bera.
    Beyond COVID-19, inconsistent public health data have been 
raised repeatedly as an issue before this Subcommittee in 
hearings. An example is that there's not a single standard for 
how to define a gun death or a maternal death.
    My legislation with Representative Peters carries out 
several recommendations from the GAO and the National Academies 
of Science to make vital health statistics electronically 
available and comparable.
    Robust and accessible public health data is a critical tool 
for our state and local officials in their efforts to address 
the social determinants of health that perpetuate the 
inequities in our communities.
    Rep. Barragan's Improving Social Determinants of Health Act 
builds on and complements the Health STATISTICS Act by 
authorizing a new CDC program that would use the improved and 
available health data to address structural challenges such as 
unsafe housing, poor transportation, or food deserts.
    The remaining bills work together to use public health data 
to address health disparities starting at conception, through 
childhood, and into adulthood.
    I'm proud that our Subcommittee is once again leading the 
charge in a bipartisan way to promote health equity through 
evidence-based, data-driven policy. Taken together, these 13 
bills will make real and lasting change to rebuild our public 
health system so we can address both new health emergencies 
like COVID-19, as well as the systemic issues of poverty and 
racial inequality.

    Ms. Eshoo. The Chair now is pleased to recognize our 
ranking member of the subcommittee, Mr. Guthrie, for 5 
minutes----
    Mr. Burgess. Madam Chair? Madam Chair? This is Burgess. I 
wonder if I could just ask for a point of personal privilege 
before Mr. Guthrie is recognized.
    Ms. Eshoo. Certainly.
    Mr. Burgess. Several people on this subcommittee are old 
enough to remember when we had a different subcommittee chair. 
And it was at that time that I was assisted so ably by my young 
staff.
    Elizabeth Allen is going to be leaving my office now. She 
has accepted a position at Boston College to get an MBA, and it 
is quite a step--needless to say, quite a step up for her.
    We have all benefited from her experience and her knowledge 
over the time that she has been associated with the Health 
Subcommittee's work. So I thought, if I could, I would just 
like to acknowledge the service of Elizabeth Allen, and perhaps 
we could give her a brief round of applause.
    Ms. Eshoo. Absolutely, thank you.
    [Applause.]
    Ms. Eshoo. And we thank her for her wonderful service and 
wish her well.
    The Chair now recognizes the wonderful ranking member of 
our subcommittee, Mr. Guthrie.

 OPENING STATEMENT OF HON. BRETT GUTHRIE, A REPRESENTATIVE IN 
           CONGRESS FROM THE COMMONWEALTH OF KENTUCKY

    Mr. Guthrie. Thank you. Thank you, Chair Eshoo, and thanks 
to Elizabeth. And I always enjoyed working with her, as well.
    So thank you for your hard work, and good luck at Boston 
College.
    And thanks for holding this important hearing today.
    Before us today we have several bills pertaining to social 
determinants of health, as well as collecting health data. I 
look forward to hearing from the witnesses regarding these 
bills.
    As currently defined by the CDC, social determinants of 
health are conditions and places where people live, learn, 
work, and play that affect a wide range of quality-of-health 
and quality-of-life risks and outcomes. I have seen and heard, 
firsthand, the benefits that Medicare Advantage can do to help 
address social determinants of health for seniors.
    For example, a recent study showed that Medicare Advantage 
plans continue to offer benefits that help Americans with their 
social determinants of health. Specifically, the study found 27 
percent of Medicare Advantage plans offered in-home services; 
57 percent offered meal delivery; 57 percent offered 
transportation services; and 11 percent offered home 
modification. Additionally, they found that 94 percent of plans 
now offer telehealth as a base benefit. These benefits can 
continue without policy changes or site-of-service 
restrictions, postpandemic.
    Since 2015 I have led the bipartisan Member letter in 
support of Medicare Advantage. In 2020 we had over 300 Members 
sign the annual letter to HHS in support of the program. It has 
been a bipartisan effort, and I want to take this opportunity 
to thank Representatives Cardenas, Blumenauer, and Kelly for 
all of their hard work on this letter.
    Medicare Advantage has demonstrated how successful private 
insurance plans can be, if given the proper flexibilities--that 
is, if my colleagues do not force Medicare for All on all 
Americans and take away this choice for nearly 29 million 
beneficiaries--nearly half of the eligible Medicare population 
that is--is estimated to choose MA for 2022. Medicare for All 
would prevent Americans from choosing this option that provides 
quality healthcare and supplemental services and helps address 
social determinants of health.
    Medicare for All will lead to worst-case scenario for 
seniors, longer wait times, and diminished patient control over 
their own healthcare.
    Today we are considering several health bills--health data 
bills. Useful health data is important, but some of the bills 
before us today are too narrow in scope and are duplicative of 
current efforts. In addition, it does not seem there is a 
consensus on what--who needs to collect what data, how it will 
be used, and who will have access to it, and how to do that in 
a way that doesn't add more administrative expense.
    COVID-19 shed light on the need for more public health data 
infrastructure, and we must use lessons learned to prepare for 
future pandemics rather than continuing to focus on COVID-19's 
specific authorities and programs.
    For example, H.R. 778 would establish new CDC grants to 
States that choose to develop and use digital contact tracing 
technology for COVID-19, which seems duplicative of programs 
that have already been funded in response to the pandemic. CDC 
has already received funds to do just that, and we should first 
evaluate how those funds are being spent.
    Additionally, H.R. 791, the Tracking COVID-19 Variants Act, 
includes provisions that will require the CDC to issue guidance 
regarding collaborations in data sharing for COVID-19 
sequencing while further enacting a pilot program by expanding 
existing data linkages. Data sequencing is already being done 
on variants today.
    Further, H.R. 976, the ETHIC Act, would retroactively 
require States to report specific COVID-19 data to the CDC as a 
condition on receiving certain COVID-19 funding. Currently, 
States are already required to report some of this data.
    I am looking forward to examining and building on ideas 
like Mr. Curtis' bipartisan legislation, H.R. 3969, which would 
allow spending on social determinants of health to be included 
in health insurance plans' medical loss ratio calculation, so 
to encourage Medicare Advantage and Medicare managed care 
organizations to take further action to support social 
determinants of health.
    I support Dr. Burgess' bill, the Social Determinants of 
Health Data Analysis Act, which would require GAO to report on 
the actions taken by the Secretary of HHS to address social 
determinants of health.
    In closing, I hope we can work in a bipartisan way to 
improve America's public health infrastructure so we are better 
prepared and ready to address the next pandemic. As we continue 
working, we need to ensure Americans' hard-earned taxpayer 
dollars are being used efficiently and not on duplicate 
efforts. I look forward to having a productive discussion today 
on how to have better healthcare data and address social 
determinants of health.
    [The prepared statement of Mr. Guthrie follows:]

                Prepared Statement of Hon. Brett Guthrie

    Thank you, Chair Eshoo, for holding this important hearing 
today.
    Before us today we have several bills pertaining to social 
determinants of health (SDOH) as well as collecting health 
data. I look forward to hearing from the witnesses regarding 
these bills.
    As currently defined by the CDC, social determinants of 
health are conditions in the places where people live, learn, 
work, and play that affect a wide range of health and quality-
of life-risks and outcomes. I have seen and heard firsthand the 
benefits that Medicare Advantage can do to help address social 
determinants of health for seniors.
    For example, a recent study showed that Medicare Advantage 
plans continue to offer supplemental benefits that help 
Americans with their social determents of health. Specifically, 
the study found 27% of MA plans offered in-home services, 57% 
offered meal delivery, 57% offered transportation services, and 
11% offered home-modification. Additionally, they found that 
94% of plans now offer telehealth as a base benefit. These 
benefits can continue without policy changes or site of service 
restrictions post-pandemic.
    Since 2015, I have led the bipartisan member letter in 
support of MA. Historically, we have had record numbers of 
members join these efforts. In fact, in 2020, we had over 300 
members sign the annual letter to HHS in support of the 
program. It has been a bipartisan effort, and I want to take 
this opportunity to thank Representatives Cardenas, Blumenauer, 
and Kelly for all their hard work on this letter. Medicare 
Advantage has demonstrated how successful private insurance 
plans can be if given the proper flexibilities.
    That is, if my colleagues do not force Medicare for All on 
Americans and take away this choice for the nearly 29 million 
beneficiaries--nearly half the eligible Medicare population 
that is estimated to choose MA for 2022. Medicare for All would 
prevent these 29 million Americans from choosing this option 
that provides quality healthcare and supplemental services that 
help address social determinants of health. Medicare for All 
will lead to worse care for seniors, longer wait times, and 
diminish patient control over their own healthcare.
    Today we are also considering several health data bills. 
Useful health data is important, but some of the bills before 
us today are too narrow in scope to address future pandemics 
and are duplicative of current efforts. In addition, it does 
not seem there is a consensus on who needs to collect what 
data, how it will be used, and who will have access to it, and 
how to do that in a way that doesn't add more administrative 
expense to our costly healthcare system. COVID-19 shed light on 
the need for more public health data infrastructure, and we 
must use lessons learned to prepare for future pandemics rather 
than continuing to focus on COVID-19 specific authorities and 
programs.
    For example, H.R. 778 would establish new CDC grants to 
states that choose to develop and use digital contact tracing 
technology for COVID-19 contact tracing program efforts, which 
seems duplicative of programs that have already been funded in 
response to the COVID-19 pandemic. CDC has already received 
funds to do just that, and we should first evaluate how those 
funds have been spent.
    Additionally, H.R. 791, the Tracking COVID-19 Variants Act 
includes provisions that would require the CDC to issue 
guidance regarding collaborations and data-sharing for COVID-19 
sequencing, while further enacting a pilot program by expanding 
existing data linkages. Data sequencing is already being done 
on variants today.
    Further, H.R. 976, the ETHIC Act would retroactively 
require states to report specific COVID-19 data to the CDC as a 
condition of receiving certain COVID-19 funding. Currently, 
states are already required to report some of this data.
    I'm looking forward to examining Mr. Curtis' bipartisan 
legislation, H.R. 3969, which would allow spending on social 
determinants of health to be included in health insurance 
plans' medical loss ratio calculation. I'm also interested in 
hearing how we can build on ideas like H.R. 3969 to encourage 
other insurance plans, like Medicare Advantage and Medicaid 
Managed Care Organizations, to take further actions to support 
social determinants of health.
    I'm also looking forward to discussing Dr. Burgess' bill, 
the Social Determinants of Health Data Analysis Act, which 
would require the GAO to report on the actions taken by the 
Secretary of HHS to address social determinants of health.
    In closing, I look forward to working in a bipartisan way 
to help improve America's public health infrastructure, so we 
are better prepared and ready to address the next pandemic. As 
we work on this, we need to ensure Americans' hard-earned 
taxpayer dollars are being used efficiently and not on 
duplicate efforts. I look forward to having a productive 
discussion today on how to have better healthcare data and 
address social determinants of health.

    Mr. Guthrie. And I yield back my time.
    Ms. Eshoo. The gentleman yields back. The Chair now is 
pleased to recognize the chairman of the full committee, Mr. 
Pallone, for his 5 minutes for an opening statement.

OPENING STATEMENT OF HON. FRANK PALLONE, Jr., A REPRESENTATIVE 
            IN CONGRESS FROM THE STATE OF NEW JERSEY

    Mr. Pallone. Thank you, Chairwoman Eshoo.
    Throughout the COVID-19 pandemic, Federal, State, and local 
public health leaders have faced barriers to collecting and 
discussing the data needed to fully respond to a public health 
crisis. It is this vital data that provides government 
officials and health leaders the critical insight needed to 
develop the best guidance in response to public health crises. 
And as a result of these barriers, public health departments at 
all levels of government have, at times, lacked the information 
they needed to better understand the significant impacts of the 
pandemic on our most vulnerable communities.
    Unfortunately, the U.S. public health surveillance 
infrastructure was fragmented and inconsistent long before this 
COVID pandemic. Insufficient funding, limited resources, 
inadequate training, combined with differing State and county 
laws and nonexistent data standardization procedures, are 
several of the many factors that limit public health data.
    The slate of bills we are considering today will make 
targeted improvements across three key areas. First, we will 
discuss establishing a uniform Federal strategic action plan, 
as well as data standards and a data sharing policy. Second, 
several of the bills we are considering will improve the 
collection of public health data that reveals the drivers of 
health inequities. And third, we will discuss proposals to 
assist States in the creation of a public health data 
infrastructure necessary to appropriately deploy resources and 
essential interventions.
    I want to commend the chair and the sponsors of these bills 
for their leadership in advancing policy solutions for some of 
our country's most pressing health policy concerns.
    Public health data is essential to the health of our 
country. It may not seem very interesting, but it is very 
important. This data allows us to understand which communities 
need resources, how many, and when. It allows us to better 
target health inequities and address them accordingly. Public 
health data also gives government and local leaders the ability 
to make upstream policy changes and implement prevention work.
    Now, many of the bills we will discuss today also address 
the importance of better understanding and researching social 
determinants of health to improve the overall health status of 
the United States. These bills take steps to eliminate the 
lingering health inequities that exist and burden some of our 
most vulnerable communities.
    Uniform data collection is imperative to better 
understanding the inequities in our healthcare system and to 
guide real change. To effectively adapt interventions designed 
to advance health equity, we have to be able to standardize and 
collect data related to key social conditions. We will hear 
from the witnesses today about legislation that will help give 
States the tools they need to design effective interventions to 
address certain social determinants of health. These 
interventions will also improve the health and well-being of 
some of our most vulnerable populations, including by expanding 
access to evidence-based tobacco cessation treatment through 
the Medicaid program.
    In finding comprehensive solutions to our fragmented public 
health data is of the utmost importance. With resources that 
Congress has provided through the COVID-19 relief packages, 
including the CARES Act and the American Rescue Plan, we know 
that data modernization is underway, and we must now continue 
that work to ensure that research labs, providers, and public 
health departments are working with real-time current data and 
have a better understanding of social determinants of health.
    So I look forward to hearing from our witnesses and working 
together with our colleagues on these legislative proposals 
today.
    Chairwoman Eshoo, I just want to say to you and the ranking 
member, you know, we are now--you know, the pandemic, 
hopefully, is winding down. But the pandemic showed us that, 
whether it was the public health infrastructure or the data 
collection--you know, I am talking about State labs, the supply 
chain, so many things that really showed that--need a lot of 
work, and didn't work well during the pandemic.
    And so I think that--I just want everyone to know that 
myself and the members of this committee--and I know you, in 
particular, Ms. Eshoo--we want to get to the bottom of this and 
make sure that we are better prepared in the future, for future 
pandemics. And that is going to mean a lot in terms of, you 
know, things that maybe don't sound very interesting but are 
important, like data collection, like infrastructure for public 
health, like the State labs, like the supply chain. It is only 
if we can improve those things that we can be better prepared 
for future pandemics, and I just want to stress that today.
    I don't know how much the media cares about this, but it is 
very important, it really is, and that is what I wanted to 
stress.
    So thank you, I yield back.
    [The prepared statement of Mr. Pallone follows:]

             Prepared Statement of Hon. Frank Pallone, Jr.

    Throughout the COVID-19 pandemic, Federal, State, and local 
public health leaders have faced barriers to collecting and 
accessing the data needed to fully respond to a public health 
crisis. It is this vital data that provides government 
officials and health leaders the critical insight needed to 
develop the best guidance and response to public health crises. 
As a result of these barriers, public health departments at all 
levels of government have, at times, lacked the information 
they needed to better understand the significant impacts of the 
pandemic on our most vulnerable communities.
    Unfortunately, the U.S. public health surveillance 
infrastructure was fragmented and inconsistent long before this 
pandemic. Insufficient funding, limited resources, inadequate 
training combined with differing state and county laws, and 
nonexistent data standardization procedures are several of the 
many factors that limit public health data.
    The slate of bills we are considering today will make 
targeted improvements across three key areas. First, we will 
discuss establishing a uniform, federal strategic action plan, 
as well as data standards, and data sharing policies. Second, 
several of the bills we're considering will improve the 
collection of public health data that reveals the drivers of 
health inequities. And third, we will discuss proposals to 
assist states in the creation of the public health data 
infrastructure necessary to appropriately deploy resources and 
essential interventions.
    I commend the Chair and sponsors of these bills for their 
leadership on advancing policy solutions for some of our 
country's most pressing health policy concerns. Public health 
data is essential to the health of our country. This data 
allows us to understand which communities need resources, how 
many and when. It allows us to better target health inequities 
and address them accordingly. Public health data also gives 
government and local leaders the ability to make upstream 
policy changes and implement prevention work.
    Many of the bills we will discuss today also address the 
importance of better understanding and researching social 
determinants of health to improve the overall health status of 
the United States. These bills take steps to eliminate the 
lingering health inequities that exist and burden some of our 
most vulnerable communities.
    Uniform data collection is imperative to better 
understanding the inequities in our healthcare system and to 
guide real change. To effectively adapt interventions designed 
to advance health equity, we must be able to standardize and 
collect data related to key social conditions.
    We will hear from the witnesses today about legislation 
that will help give states the tools they need to design 
effective interventions to address certain social determinants 
of health. These interventions will also improve the health and 
well-being of some of our most vulnerable populations, 
including by expanding access to evidence-based tobacco 
cessation treatment through the Medicaid program.
    Finding comprehensive solutions to our fragmented public 
health data is of the utmost importance. With resources that 
Congress has provided through COVID-19 relief packages, 
including the CARES Act and the American Rescue Plan, we know 
that data modernization is underway. We must now continue that 
work to ensure that research labs, providers and public health 
departments are working with real-time, current data and have a 
better understanding of social determinants of health. I look 
forward to hearing from our witnesses and working together with 
my colleagues on the legislative proposals before us today.
    Thank you, I yield back.

    Ms. Eshoo. Thank you, Chairman, and it is exactly why we 
are bringing these 13 bills forward, and have the outstanding 
witnesses that are with us today to give us their opinion, 
given their background and experience.
    The Chair now is pleased to recognize the ranking member of 
the full committee, Congresswoman Cathy McMorris Rodgers, for 
her 5 minutes for an opening statement.

      OPENING STATEMENT OF HON. CATHY McMORRIS RODGERS, A 
    REPRESENTATIVE IN CONGRESS FROM THE STATE OF WASHINGTON

    Mrs. Rodgers. Thank you, Madam Chair.
    Social and economic conditions have a powerful influence on 
our health and well-being. Dependable transportation, job 
security, and access to healthy foods are all factors that make 
a difference in the prevention and management of many 
conditions like diabetes, heart disease, and obesity.
    Today 9.3 million Americans are currently on the sidelines 
and out of work. Unemployed individuals are more likely to 
suffer from illnesses such as high blood pressure, stroke, 
heart attack, and arthritis. Unemployment leads to worse health 
outcomes, on average, for all workers, regardless of their 
baseline measure of health. It is a cycle of despair that must 
be broken to promote healthier families.
    We need to get Americans back to work. People need hope and 
a purpose. It means more than a job. It is about dignity and 
the opportunity for a better life. And we are only at the 
beginning of understanding the impact of the pandemic lockdowns 
on mental health. This is a crisis. One hospital I talked to 
said social isolation is the biggest concern for seniors, not 
to mention the rise in mental health emergencies that we have 
seen for our children.
    For hope and real results, we should be looking to how the 
private sector and communities are leading the way for 
healthier futures. In my district, to help people without 
transportation, Washington State University partnered with 
Range Health to purchase a mobile health unit to provide 
primary care, noninvasive procedures, and preventative 
screenings for underserved, rural communities. Some ride share 
apps are also allowing eligible patients to order rides to and 
from doctors' appointments, often paid for by health insurance 
companies. Meal delivery services are also helping seniors 
access nutritional food. And Medicare Advantage offers coverage 
options for these services.
    According to a recent CMS report, 60 percent of Medicare 
Advantage beneficiaries are enrolled in a plan that offers food 
assistance. The number of seniors that choose Medicare 
Advantage plans offering these supplemental benefits like food 
assistance, housing, pest control tripled between 2020 and 
2021. I look forward to listening to and learning more from our 
witnesses today on how Medicare Advantage flexibilities are 
helping address social determinants of health in our seniors 
and what more that we can do to incentivize the private sector.
    In 2021 Medicare Advantage plans covered 26 million people, 
which is a little over 40 percent of the entire Medicare 
population. Seniors from all walks of life are choosing these 
private-run plans over government-run fee-for-service plans. 
They are spending less and getting better preventative care 
because of it.
    I am extremely concerned by proposals from my Democrat 
colleagues that would ban Medicare Advantage plans and move 
everyone to a one-size-fits-all, government-run plan. The 
Federal Government should provide incentives and enable the 
private sector to tackle these social determinants in a way 
that empowers local communities. However, as we look at data 
policies, we need to be very clear with the American people 
about who is collecting what data and how it will be used.
    Some of the bills today authorize enormous sums of money 
before we even have a clear understanding of what the private 
sector, State, local, and Federal Government is already doing 
and what is working. That approach may work in scoring some 
political points, but it doesn't drive results.
    I also have concerns continuing short-sighted, COVID-19-
specific legislation. I recently spoke with former CDC Director 
Dr. Redfield. He said that the big pandemic is yet to come. We 
don't know that it will be coronavirus, pandemic flu, or 
something entirely new. We need to be working on preparing data 
systems and public health for all threats, not just COVID, and 
take into account where these systems are after the large 
investment and lessons learned from COVID-19.
    We should be empowering innovative methods that are backed 
by trust--trusted data--to address social determinants of 
health. Doctors, hospital, State and local governments, 
communities groups, and health insurers are leading the way, 
tackling social determinants of health. We need to enable their 
continued leadership and success and remove any arbitrary 
roadblocks.
    [The prepared statement of Mrs. Rodgers follows:]

           Prepared Statement of Hon. Cathy McMorris Rodgers

SOCIAL DETERMINANTS OF HEALTH
    Thank you, Madam Chair.
    Social and economic conditions have a powerful influence on 
our health and well-being.
    Dependable transportation, job security, and access to 
healthy foods are all factors that make a difference in the 
prevention and management of many conditions like diabetes, 
heart disease, and obesity.
    Today, 9.3 million Americans are currently on the sidelines 
and out of work.
    Unemployed individuals are more likely to suffer from 
illnesses such as high blood pressure, stroke, heart attack, 
and arthritis.
    Unemployment leads to worse health outcomes on average for 
all workers, regardless of their baseline measures of health.
    It's a cycle of despair that must be broken for healthier 
families.
    We need to get Americans back to work.
    People need hope... and a purpose. It means more than just 
a job. It's about dignity and the opportunity for a better 
life.
    And we're only just beginning to understand the impact of 
pandemic lockdowns on mental health.
    This is a crisis. One hospital I talked to said social 
isolation is the biggest concern for seniors...
    ..not to mention the rise in mental health emergencies 
we've seen for our kids.
    For hope and real results, we should be looking to how the 
private sector and communities are leading the way for 
healthier futures. .
PRIVATE SECTOR
    In my district, to help reach people without 
transportation, Washington State University partnered with 
Range Health to purchase a mobile health unit to provide 
primary care, noninvasive procedures, and preventative 
screening for underserved, rural communities.
    Some rideshare apps are also allowing eligible patients to 
order rides to and from doctors' appointments, often paid for 
by health insurance companies.
    Meal delivery services are also helping seniors access 
nutritious food..and Medicare Advantage offers coverage options 
for these services.
    According to recent CMS data, 60% of Medicare Advantage 
beneficiaries are enrolled in a plan that offers food 
assistance.
    The number of seniors that chose Medicare Advantage plans 
offering these ``supplemental benefits,'' like food assistance, 
housing, pest control tripled between 2020 and 2021.
    I look forward to listening to and learning more from our 
witnesses today on how Medicare Advantage flexibilities are 
helping address social determinants of health in our seniors...
    . what more we can do to incentivize the private sector.
    In 2021, Medicare Advantage plans cover 26 million people, 
which is a little over 40 percent of the entire Medicare 
population. Seniors from all walks of life are choosing these 
private run plans over government run fee-for-service plans.
    They are spending less and getting better preventive care 
because of it.
    I'm extremely concerned by proposals from Democrat 
colleagues that would ban Medicare Advantage plans and move 
everyone to a one-size-fits all government run plan.
    Concerns with Legislation
    The federal government should provide incentives and enable 
the private sector to tackle these social determinants in ways 
that empower local communities.
    However, as we look at data policies, we need to be very 
clear with the American people about who is collecting what 
data, and how it will be used.
    Some of the bills today authorize enormous sums of money 
before we even have a clear understanding of what the private 
sector, state, local, and federal governments are already doing 
and what is working.
    That approach may work to score political points, but it 
doesn't drive real results.
    I also have concerns continuing short-sighted COVID-19 
specific legislation. I recently spoke with former CDC Director 
Robert Redfield.
    He said the big pandemic is yet to come.
    We don't know if that will be a coronavirus, pandemic flu, 
or something entirely new.
    We need to be working on preparing data systems and public 
health for all threats, not just COVID, and take into account 
where these systems are after the large investment and lessons 
learned from COVID-19.
CONCLUSION
    We should be empowering innovative methods--that are backed 
by trusted data--to address social determinants of health.
    Doctors, hospitals, state and local governments, community 
groups, and health insurers are leading the way in fighting 
social determinants of health.
    We need to enable their continued leadership and success 
and remove any arbitrary roadblocks.
    I'm looking forward to today's discussion and I yield back.

    Mrs. Rodgers. I am looking forward to today's discussion, 
and I yield back.
    Ms. Eshoo. The gentlewoman yields back. I thought I knew 
just about everything in terms of benefits in Medicare 
Advantage. I didn't know that pest control was one of them.
    The Chair would like to remind Members that, pursuant to 
committee rules, all Members' written opening statements will 
be made part of the record.
    I now would like to introduce our witnesses.
    Dr. Karen DeSalvo is the chief health officer for Google 
Health. She previously served as the Acting Assistant Secretary 
for Health and the national coordinator for health information 
technology at HHS.
    Welcome, Dr. DeSalvo, we are thrilled to have you with us.
    Dr. Romilla Batra is the chief medical officer for the SCAN 
Health Plan, which is one of our Nation's largest not-for-
profit Medicare Advantage plans.
    Welcome to you.
    Ms. Beth Blauer is the assistant vice provost for public 
sector innovation and the data lead for the Johns Hopkins 
University's Coronavirus Resource Center.
    Welcome to you. We look forward to your testimony.
    Dr. Faisel Syed is the national director of primary care 
for ChenMed, which is a fully capitated primary care practice 
for seniors. He is also testifying on behalf of the America's 
Physician Groups.
    Welcome to you, and we all look forward to your testimony.
    And Dr. Kara Odom Walker, who is the executive vice 
president and the chief population health officer for the 
Nemours Children's Health System.
    So welcome to each one of you. The entire subcommittee is 
very grateful that you have agreed to testify.
    And Dr. DeSalvo, you have--you are recognized for 5 minutes 
for your testimony, and please unmute.

  STATEMENT OF KAREN B. DeSALVO, M.D., CHIEF HEALTH OFFICER, 
GOOGLE HEALTH; ROMILLA BATRA, M.D., CHIEF MEDICAL OFFICER, SCAN 
HEALTH PLAN; BETH I. BLAUER, EXECUTIVE DIRECTOR, JOHNS HOPKINS 
    UNIVERSITY CENTERS FOR CIVIC IMPACT; FAISEL SYED, M.D., 
   NATIONAL DIRECTOR OF PRIMARY CARE, CHENMED; AND KARA ODOM 
 WALKER, EXECUTIVE VICE PRESIDENT AND CHIEF POPULATION HEALTH 
           OFFICER, NEMOURS CHILDREN'S HEALTH SYSTEM

              STATEMENT OF KAREN B. DeSALVO, M.D.

    Dr. DeSalvo. Thank you, Chairwoman Eshoo, Ranking Member 
Guthrie, and distinguished members of the committee. I 
appreciate the opportunity to appear today. My name is Dr. 
Karen DeSalvo, and I am a physician and former local and 
national public health official who has spent my career working 
at the intersection of clinical care, public health, and 
digital innovation to improve the conditions in America's most 
vulnerable communities.
    Currently I serve as the chief health officer at Google and 
remain engaged in efforts to address the public's health 
collaboratively, including through my role as coconvener of the 
National Alliance to Impact the Social Determinants of Health 
with former HHS Secretary, Michael Leavitt and as a member of 
the Robert Wood Johnson Foundation National Commission to 
Transform Public Health Data Systems.
    Today's hearing takes place at an historic moment, as we 
chart the road to recovery from the greatest public health 
emergency in over a century. I applaud the subcommittee for 
their leadership during the pandemic and for advancing a bold 
vision for public health transformation that intersects with 
data modernization and health equity. The vision recognizes how 
COVID-19 pulled back the curtain on the structural failings 
that contribute to inequities in our current public health 
system: chronic underfunding, obsolete digital infrastructure, 
and longstanding capacity gaps.
    I have seen these shortcomings firsthand. That is why I 
believe building resilient and equitable public health systems 
begins with crosscutting solutions, a theory of change that is 
captured in the Public Health 3.0 framework. I am excited that 
many of the proposed bills in today's hearing share this ethos, 
and offer the following recommendations to inform the 
subcommittee's vital work.
    First, while data analytics and IT infrastructure are 
important, it is imperative that legislation and policymaking 
focus on the systems that collect, exchange, and act on data, 
rather than the data itself. Recently proposed legislation for 
the Public Health Infrastructure Fund highlights the stable 
foundation of resources that health departments will need, from 
infrastructure upgrades to workforce investments and 
operational design.
    Second, public-private partnerships can maximize the value 
of data for governmental public health. There are numerous 
examples of such partnerships during COVID-19. To optimize 
these beyond the pandemic, we need to develop data 
infrastructure within public health focused on racial and rural 
disparities like the ones proposed in the bills today.
    Third, achieving equity requires expanding our 
understanding of what data can be useful. Projects like our 
Google COVID-19 Search Symptoms Trends show how public health 
can leverage novel data signals in a privacy-preserving manner 
to inform research and public health decision making, such as 
where to dedicate more resources. In addition, data systems 
aimed at addressing inequities should integrate sources from 
the social and human services sectors.
    Fourth, data systems need to be built to describe and 
address inequities, not only at the individual level but at the 
system level too. For example, knowing that kids in a certain 
neighborhood are unhealthy is just one step. But understanding 
where kids might not have access to sidewalks and playgrounds 
could help communities take action.
    Fifth and finally, the CDC's data modernization initiative 
would benefit from incorporating the lessons learned from high 
tech, the opportunities to do more than rewire the current 20th 
century public health systems, but to reimagine it. 21st 
Century Cures articulated such a vision by advocating the use 
of open--standards and FHIR-based application programming 
interfaces, or APIs, for the healthcare system. The same can be 
used for public health.
    We should also ensure that States and localities are not 
rushed in spending the funds and that they have an 
appropriately resourced workforce to maximize impact.
    In closing, I want to reiterate my thanks for the 
opportunity to testify and emphasize the critical importance of 
the topics covered in today's hearing. I look forward to 
working with the subcommittee on opportunities to strengthen 
our Nation's public health infrastructure to achieve health for 
all equitably. I look forward to your questions.
    [The prepared statement of Dr. DeSalvo follows:]
    
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    Ms. Eshoo. Thank you very much, Dr. DeSalvo.
    Next, Dr. Romilla Batra, you are recognized for your 5 
minutes of testimony.

                STATEMENT OF ROMILLA BATRA, M.D.

    Dr. Batra. Thank you so much. Good morning, Chairwoman 
Eshoo, Ranking Member Guthrie, and distinguished members of the 
Health Subcommittee. My name is Romilla Batra. I am a primary 
care physician and chief medical officer of SCAN Health Plan. 
Thank you for giving me the opportunity to address how SCAN 
addresses social determinants of health, what supplemental 
benefits we provide, and our recommendations. My remarks will 
briefly cover who we are, how do we serve our members and our 
communities, and our focus on the older adult population at 
large.
    SCAN stands for Senior Care Action Network. We were founded 
in 1977, and we are a not-for-profit MA plan. We are a mission-
based organization, and our mission is keeping seniors healthy 
and independent. And the true story is it was started by 12 
angry seniors who truly believed there was more to health than 
doctors and medications and nursing homes. They wanted to age 
in place and live in their communities. They were the true 
pioneers who knew why social determinants of health are so 
important to be fulfilled.
    And since then we have taken care of that population. We 
have provided a special needs plan, and we are the only plan in 
California to offer a fully integrated, dual-eligible special 
needs plan. We serve about 220,000 beneficiaries in California, 
and we have been consistently CMS-ranked a 4.5-star plan, so we 
are really proud of the quality of care that we provide.
    Addressing social determinants of health is really 
important to improve health outcomes, as these factors 
represent 70 percent of the drivers affecting a person's 
overall health status. We see that in studies. We see that also 
in our data. So our approach to addressing social determinants 
of health is identifying what the social risks are, stratifying 
the population so we can match them with programs and benefits, 
serving our members and clients, measuring the impact, scaling 
the programs, and, as a not-for-profit organization, running 
our own community-based organization in the community that 
serves older adults and their caregivers.
    In terms of identification, we have consistently done 
health risk assessment to gather not only health data but also 
social needs data as well as demographic data. That is race and 
language, including newly started sexual orientation and gender 
identification data. We have data on 90 percent of our 
population on their race and language, which really helps us 
serving them better.
    In terms of stratifying and serving them, we offer 
different programs. I would like to quickly highlight one of 
them. It is a member-to-member program, where we take our own 
members, who then are our employees, train them in motivational 
interviewing. They then engage with our members, help them 
around social isolation, addressing their social needs, mental 
health. Last year we were able to reach out to about 10,000 of 
our members through this program. We had a very high adoption 
rate of 50 percent, and saw a statistically significant 
improvement in things like incontinence, falls, physical 
activity, and social isolation.
    On the other extreme, we also have programs like connecting 
provider to home, where we have a social worker and a community 
health worker from a community that addresses the needs of the 
top 1 percent of our population who have high social burden and 
high medical burden. A great story of Mr. M, who lived in a 
mobile home, had a history of falling, did not have access to 
food, did not have access to resources to pay for his utility 
bills. A community health worker was going--was able to stop 
in, helped with filling out forms for application for Medicare, 
get assistance from community around utility payments, able to 
connect them with benefits around food, as well as able to go 
over the doctor's appointment to help with the DME. Those are 
the kind of things that make a difference in terms of their 
health outcomes.
    We continue following our data to find where there are 
unmet needs and addressing supplemental benefits to address 
them. In terms of our supplemental benefits, we are very 
grateful for the Congress for helping us do the flexibility. 
Because of the flexibility, we are able to offer multiple 
benefits. I will highlight one of them. It is called the Return 
to Home Benefit, which addresses the needs of older adults 
getting discharged to their home. We provide in-home 
caregiving, meals, homemaking services, care coordination to 
pick up that medication, as well as caregiving support.
    Finally, my recommendation would be that, as a not-for-
profit MA plan with a long history of serving older adults, 
these are very important needs. We ask that Congress include 
SDOH such as food insecurity to the criteria for supplemental 
benefits more broadly than only specific chronic conditions.
    Finally, we recommend you consider supporting H.R. 2166, 
Ensuring Parity in MA and PACE for Audio-Only Telehealth bill. 
Wi-Fi access became a huge social determinant of health need 
during the pandemic, and digital divides were huge, so we truly 
believe this can make a difference.
    There is also a Senate companion bill, Ensuring Parity in 
MA Audio--for Audio-Only that we would love--like to recommend.
    On behalf of SCAN, thank you for your ongoing commitment to 
improving the care for older adults. We welcome the opportunity 
to be a resource to members of this committee, if you can be of 
service. Thank you again for the honor to speak before this 
distinguished committee. Thanks.
    [The prepared statement of Dr. Batra follows:]
    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
    
    Ms. Eshoo. Thank you. Thank you, Dr. Batra.
    I think that it would be really helpful if the witnesses--
because this is a legislative hearing--and with the 
extraordinary experience and background that you all have, if 
you could weave into your comments if you think we are hitting 
the mark with any one of these bills. Any suggestions, 
critiques, comments about them, I think, would be most helpful 
to the members of this subcommittee.
    Next, Ms. Blauer, it is a pleasure to welcome you again. 
Thank you. And you are recognized for your 5 minutes of 
testimony.

                  STATEMENT OF BETH I. BLAUER

    Ms. Blauer. Thank you very much, Chairman Eshoo, Ranking 
Member Guthrie, and members of the subcommittee. Thank you for 
inviting me to participate in today's hearing and for 
dedicating your time to an examination of the role of data and 
health outcomes.
    My first job in the public sector was nearly two decades 
ago, when I worked as a juvenile probation officer for the 
State of Maryland. I left the State after leading an ambitious, 
cross-government data initiative that was credited with 
significant outcomes for residents, ranging from market 
reductions in infant mortality, nation-leading school 
performance, and record low crime rates. Since 2015 I have led 
a center at Johns Hopkins University focused on building the 
capacity of local leaders to use data to improve outcomes. And 
for the last 17 months, I have been the data lead for the Johns 
Hopkins University Coronavirus Resource Center. I have seen the 
very best and the very worst of data use.
    The bills that are the subject of today's hearings go a 
long way to realign Federal resources with interventions that 
are proven, measurable, and focused on ending multigenerational 
health and well-being disparities.
    In the last 18 months, governments at all levels did 
something incredibly remarkable. They built data collection 
efforts, shared data, and made real-time decisions based on 
near-time data. Never before has the Nation endeavored to 
realize a coordinated effort around data sharing, data-informed 
decision making, and collective outcome measurement at such 
scale. Local and State governments used every possible lever to 
stall the spread of this disease, including the very difficult 
decisions of closing businesses and schools.
    What has this last year taught us about using data to 
collectively solve problems? At the Johns Hopkins Coronavirus 
Resource Center, we became a trusted resource for millions of 
viewers worldwide. Over the course of weeks, JHU developed a 
methodology for scraping public data and encouraged State and 
local governments to share their data in standardized ways. JHU 
data scientists set up an internal governance and articulated 
standard collection methods under the guidance of public health 
and medical experts. We openly shared the entire process with 
the public.
    By January 2021 we had accrued more than a billion views. 
Our audience included news outlets, local governments, and 
everyday people that were making deeply personal decisions 
about how they would navigate their public lives. The backdrop 
to our entire pandemic experience was and continues to be a 
hunger for sound, publicly available data.
    This Congress has an opportunity to capitalize on the 
public demand for data, the financial investments we have 
already made in data infrastructure, and the newly minted 
analytic skill that has emerged across government during COVID-
19, and improve upon the systems to provide accountability, 
accessibility, consistency, equity, and sustainability. But 
there are some lessons that I can offer that have been helpful 
over the course of my public-sector career.
    First, we need data standards. The first instinct when you 
consider strengthening a data practice is to think about IT 
modernization or tools. But the truth is, one of the most 
important elements of a strong data practice is actually in the 
governance and the alignment of creating a common language and 
rules around how and why data is collected and applied to 
problem solving. This will not be solved by one agency. This is 
an interagency dilemma that requires a centralized 
administrative focus.
    Second, we must invest in better demographic data 
collection. State and Federal demographic data does not align. 
Inconsistencies and categorization between States, and even 
within States, make data incomparable and can obfuscate the 
disproportionate effects that the pandemic--and, in reality, 
all programs--targeted, entrenched social determinants of 
health have had on people of color. Without standards there is 
no way to analyze available data to locate vulnerable 
populations, and appropriately intervene.
    Finally, whenever possible, we must make data public. While 
I applaud that many of these bills require data collection in a 
manner that is anonymized, disaggregated, and stratified, they 
do not at all provide a plan for public dissemination. These 
data will be high quality, high resolution, and in high demand.
    Government will not be able to turn the tide on social 
determinants of health alone. It will require deep coordination 
and public engagement in the most intimate of ways. Our centers 
at JHU continue to work to build the capacity of local leaders 
to use more data as they examine their practice, and architect 
on-the-ground strategies to deliver better outcomes for people. 
But they need the support of our partners within the Federal 
Government to have the greatest impact.
    I am so thankful to be included in the hearing today, and I 
look forward to fielding any questions. Thank you.
    [The prepared statement of Ms. Blauer follows:]
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    Ms. Eshoo. Well, we are very thankful to you. Your 
testimony was highly instructive.
    Next it is a pleasure to once again welcome and thank Dr. 
Faisel Syed for--and you are now recognized for your 5 minutes 
of testimony.

                 STATEMENT OF FAISEL SYED, M.D.

    Dr. Syed. Thank you, Chairwoman Eshoo, Ranking Member 
Guthrie, and members of the subcommittee. I am Dr. Faisel Syed, 
and I am honored to testify on behalf of America's Physician 
Groups.
    APG is a national professional organization that represents 
over 300 physician groups and 195,000 physicians who provide 
care to nearly 45 million patients. APG member organizations 
share a vision to transition from a fee-for-service system to a 
value-based system, where physician groups are accountable for 
the cost and quality of care.
    I always wanted to be a doctor. I was appalled that people 
died because they had no access to medical care. I joined one 
of the largest FQHCs in the country because they treated 
everyone the same, regardless of their ability to pay. Today I 
am the national director of primary care for ChenMed. We are a 
fully capitated primary care practice for senior citizens. But 
I am also a son. And today's hearing is about my dad.
    Dad was an inventor, but then he got sick: heart disease, 
diabetes, chronic low back pain, and memory loss. Dad saw five 
specialists but not a PCP. None of them spoke with each other. 
Dad was taking pills for side effects from other pills. I 
convinced him to sign up for a Medicare Advantage plan, where a 
PCP would coordinate his care. Today Dad's heart function is 
normal, his diabetes is under control, his back pain and memory 
loss are gone, and he is on very few meds. So when we talk 
about Medicare Advantage, I think about Dad and people in this 
country like him, who are older and medically complex.
    My patients are over 70 years old, suffer from 5 or more 
chronic medical conditions, and live on fixed incomes. These 
people fought in wars and marched for civil rights. Today they 
are some of the most underserved in America.
    We claim to have the world's best healthcare system, and if 
you have money, the care you get is remarkable. But the color 
of your skin, the balance in your bank account, and the diploma 
hanging on your wall have more to do with staying healthy than 
pathophysiology. We cannot improve healthcare for everyone if 
the access to healthcare or healthy lifestyles are beyond 
someone's means. Low-income and minority populations in the 
United States don't live as long as more affluent Americans. 
There are ZIP Codes in New Orleans where life expectancy is 
only 54 years old. In more affluent ZIP Codes a few miles away, 
life expectancy is close to 80.
    Medicare Advantage is the great equalizer and plays an 
instrumental role in the transformation of our Nation's 
healthcare system. It rewards physicians who participate in 
high-risk contracts for the value of their services. The 
Medicare Advantage value-based payment arrangement creates 
three distinct advantages: a team-based primary care delivery 
system; incentives for delivering primary care in the right 
setting; and a holistic approach that addresses the patient's 
mental health, behavioral health, and home environment needs. 
Medicare Advantage acknowledges that 70 percent of medical 
outcomes are based on patient lifestyle.
    I can offer tailored solutions to people with food and 
housing insecurities, health literacy, and transportation 
issues. Because we are fully capitated, I can focus on 
prevention and early intervention. I invest the time it takes 
to build trust and influence patient behavior. Thanks to 
Medicare Advantage, I can offer exercise classes to patients 
who are afraid to take a walk through their neighborhoods, on-
site medication pickup to patients who have no way to get to a 
pharmacy, social services to help patients eat healthier. And I 
can see patients as often as needed to prevent little problems 
from becoming big ones.
    I had a patient once who was an uncontrolled diabetic. He 
refused to take insulin. Medicare Advantage gave me the time to 
get to know him. He told me about living on a fixed income and 
not having enough money to buy groceries. I earned his trust. 
He drank six to nine sodas every day. I made a deal with him. I 
wouldn't bug him about the insulin if he cut back on the soda. 
I suggested he drink seltzer with artificial sweetener. It 
turns out he liked the fizz more than the soda. Within a few 
months we got his blood sugar under control without a single 
shot of insulin. That is the beauty of Medicare Advantage.
    At ChenMed we practice a high-touch preventative model. Our 
patients have 35 percent fewer emergency room visits and 51 
percent fewer hospitalizations than the average Medicare 
beneficiary. We did a survey, and 94 percent of our patients 
said they were highly satisfied with the care they received. 
Our model fulfills the promise of Medicare Advantage and 
restores the sacred doctor-patient relationship. Let's 
prioritize what is working and make it better. Thank you.
    [The prepared statement of Dr. Syed follows:]
    
    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
    
    Ms. Eshoo. Thank you, Doctor. Maybe it will come up during 
the questions from Members, but I want to remind the witnesses 
that this hearing is about public health agencies in the 
country. It is wonderful to hear about how wonderful Medicare 
Advantage is, but we have 13 bills that we are examining in 
this legislative hearing today, so I hope that those that are 
not speaking to those, that your experience will be probed by 
Members as to what is before us, and that is the 13 bills that 
we are examining today, to see if we are on the mark or off the 
mark, and if we can do better, and what is missing, and all of 
that.
    So it is a pleasure to recognize Dr. Kara Odom Walker, and 
you are recognized for your 5 minutes of testimony. And thank 
you again for being willing to be a witness.

              STATEMENT OF KARA ODOM WALKER, M.D.

    Dr. Walker. Thank you so much. Good morning, everyone, and 
Chairwoman Eshoo, Chairman Pallone, Ranking Members McMorris 
Rodgers and Guthrie, and distinguished members of the 
committee. My name is Dr. Kara Odom Walker, and I am executive 
vice president and chief population health officer at Nemours 
Children's Health, and I am honored to testify to get--today, 
and hope to speak to some of those questions.
    Nemours is one of the Nation's largest and--pediatric 
health systems, including 2 freestanding children's hospitals 
and a network of nearly 80 primary and specialty care practices 
across 5 States. We seek to transform the health of children by 
adopting a holistic health model that utilizes innovative, 
safe, and high-quality care while also caring for the health of 
the whole child beyond medicine.
    Decades of research demonstrate that substantially reducing 
disparities requires a multigenerational approach, starting in 
the early years of a child's life, and with the help of the 
mother. We know that children who live in the most economically 
disadvantaged counties in America die at rates up to 5 times 
those of their peers in the--and are 3 times more likely to 
lack regular access to healthy food--times more likely to drop 
out of high school.
    If effectively implemented and designed in consultation 
with those they intend to serve, numerous policy approaches can 
substantially reduce disparities and improve health. Nemours is 
appreciative that the subcommittee is considering legislation 
to advance these aims.
    Nemours supports the Caring for Social Determinants of 
Health Act and commends Congresswoman Lisa Blunt Rochester and 
Congressman Gus Bilirakis for introducing this bill. It would 
require the Secretary of Health and Human Services to update 
guidance to State health officials regarding strategies to 
address social determinants of health in Medicaid and CHIP. 
This bill would ensure that, as new bright spots and approaches 
emerge, they are disseminated to States to spread what works.
    Nemours also appreciates the subcommittee's consideration 
of the Quit Because of COVID-19 Act introduced by Congresswoman 
Lisa Blunt Rochester and Congressman Brian Fitzpatrick. This 
bill would expand coverage of comprehensive tobacco cessation 
services for individuals--Medicaid and CHIP. One of the many 
benefits of increased access to cessation services and 
decreased tobacco use is the potential for reduced secondhand 
smoke exposure in infants and children. This would also help 
address disparities. Despite similar or lower smoking rates 
compared to other racial and ethnic groups, African Americans 
have the highest rates of tobacco-related cancer and are more 
likely to die from the disease. As a family physician, I am 
strongly supportive of H.R. 2125.
    Nemours also supports the Improving Social Determinants of 
Health Act and the Social Determinants Accelerator Act, which 
would invest in Federal, State, local, and organizational 
capacity to address the social determinants of health. One 
social factor of particular importance to the health of 
children is the health of their mother, which is why Nemours 
supports the Data to Save Moms Act and the Social Determinants 
for Moms Act. We believe these bills are a very important step 
in addressing maternal health outcomes.
    Another important opportunity relates to data sharing 
across sectors. In my prior role as the secretary of health and 
social services in Delaware, I saw firsthand that, with the 
right data and technology systems, it was possible to better 
identify high-risk populations, reveal where disparities exist, 
and implement targeted interventions at the individual and 
population level.
    We are seeing pockets of innovation across the country and 
making exciting progress in Delaware--the Delaware integrated 
data system in order to integrate data across multiple agencies 
that provide services to families. We in Delaware are launching 
a screening tool to help identify special needs, partnering 
with Delaware 211, and creating a central resource.
    To catalyze and spread this needed innovation, Nemours 
supports the LINC to Address Social Needs Act, which would also 
support public-private partnerships to develop or enhance 
integrated, cross-sector solutions. We believe that--for 
delivery and payment models, and you have heard a bit about how 
that can happen. So pairing with work to advance and 
incentivize valuable payment and delivery models can 
incentivize health.
    The COVID-19 pandemic laid bare the inequities that exist 
across so many domains. Out of this historic challenge is an 
opportunity to rethink the way we deliver healthcare, starting 
with pediatrics. We encourage the subcommittee to build on this 
tremendous legislative work stemming from today's hearing to 
facilitate and incentivize--and family health models--the data. 
We look forward to continuing to work with you to advance 
equity and help create the healthiest generations of children.
    [The prepared statement of Dr. Walker follows:]
    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
    
    Ms. Eshoo. Thank you very much for your testimony, Dr. 
Walker.
    We will now move to Member questions, and the Chair 
recognizes herself for 5 minutes.
    To Dr. DeSalvo, you were the health commissioner of the 
City of New Orleans. Describe for us, please, the public health 
data that was available to you in that position. How old was 
it? How was it collected? Was there the ability to share with 
other community-based organizations?
    And also, describe the ideal for public health data for 
local health officers. Would it be real-time? Would it be 
accessible? Would it be shareable?
    And any comments, recommendations, critiques you have of 
the bills that are being considered today?
    Dr. DeSalvo. Thank you, Congresswoman. Yes, I had the great 
honor of serving the people of New Orleans. It was at a time 
when data systems were even more nascent than they are now. And 
we had to do a lot of work to just understand what was on the 
minds of the people in our community, through coffees in 
community centers or in church halls. And it was an inefficient 
and incomplete way to really understand the health of our 
community.
    I had to do that kind of work, in addition to the 
quantitative data I had, because, to your question, a lot of 
the data and information local health officers even have now is 
stale, old, a couple of years, often. So I am--I was looking in 
the rearview mirror and didn't have a good sense of what was 
happening in the now for my community, much less how to 
forecast what might be happening in the future.
    There were--when you are a local health officer, you also 
have this sense, Congresswoman, that you are swimming in data 
all around you, but you don't have access because it is in 
silos, whether that is in electronic health records or in--even 
public health data systems. And it isn't designed or built to 
be interoperable and give you the answers that you need about 
inequities, for example.
    So the ideal systems are really ones that are, by design, 
thinking about data harmonization, and the committee is looking 
at some bills like H.R. 2503 that talk about the important need 
to, by design, build open standards that are interoperable so 
all these systems talk to each other.
    We have good standards that we can draw from that we began 
to build for the healthcare system. So a different use, it is 
in public health, but basically it is a way to measure things 
like blood pressure consistently and record that.
    The same thing for an important public health challenge 
like maternal mortality, which you mentioned.
    So we have to be able to have a standard way that 
communities can collect and then act on the data.
    I would say the other important component of the data 
systems is to feel more comfortable using novel signals. This 
is the imperative in the 21st century. And there is work that, 
for example, using information on public sentiment, or in our 
case we have made available a search symptoms trends data that 
can give information about what is on the community's minds. 
And the way I used to go into the church hall and talk to 
folks, it is another way to get more quantitative information 
that is anonymized and private to augment other data systems. 
And it is more timely, actionable, granular than the kind of 
data that most public health has right now.
    Ms. Eshoo. That is fascinating. Let me ask Ms. Blauer and 
Dr. DeSalvo. In both of your written testimonies you say that 
hospital data is some of the most reliable data.
    And Dr. DeSalvo, I was especially struck by your point that 
hospital records are what enabled health officials to sound the 
alarm about the Flint water crisis. So my question is, why is 
hospital data so reliable, and how can we make this data more 
widely available to local health departments?
    I am assuming that there isn't interoperability between the 
public agency and the hospitals.
    Dr. DeSalvo. Congresswoman, in the HITECH Act we invested 
resources to digitize healthcare. So now we have relatively 
reliable data in the healthcare systems that we have already 
shown can be used for public health crises like identifying 
Flint. There is a system in New York City that can identify 
chronic disease. And in Massachusetts there are also systems 
that can look for communicable disease outbreaks.
    So--but there are some examples where we know that that 
data is helpful in identifying public health challenges. The 
reality is, also, that in HITECH public health wasn't resourced 
to be able to receive that data and anonymize it and make use 
of it in the way that Dr. Blauer has, for example, in some of 
the work that she has done to create dashboards that really--
they can be useful to the community and to the country. So it 
is an untapped resource that--but there are some great 
examples.
    I might even call out Oklahoma, another State that has been 
using EHR data to look for public health challenges. But it 
needs to be scaled. We need to do more to make sure that those 
systems are interoperable. And this is an historic opportunity 
in the bills that you have before you to begin to move in that 
direction, to really think about designing with a standardized 
approach and being able to make that information useful, not 
just for individuals but also for the public's health.
    Ms. Eshoo. Yes, most helpful, most helpful. Thank you.
    The Chair now recognizes our wonderful ranking member, Mr. 
Guthrie, for your 5 minutes to question.
    Mr. Guthrie. Thank you, Madam Chair. I appreciate that. I 
appreciate the recognition.
    Actually, if you look at Mr. Curtis' bill, he is looking at 
changing the medical loss ratio to incentivize spending on 
social determinants of health, such as Medicare Advantage plans 
do and I think Medicaid managed care does, as well. And Dr. 
Burgess' bill looks at collecting data on social determinants 
of health so that we can use this information.
    I think what Medicare Advantage does is important in order 
to lay out what private health insurance plans, if they had the 
flexibility, would do. And I have a couple of questions.
    One, Dr. Batra and Dr. Syed, if you could address this--you 
know, and I know the reality of it, but one of the criticisms, 
which I think is inaccurate, is that, if you have Medicare 
Advantage plans, they cherry-pick--you cherry-pick who is in 
your plan. And therefore, obviously, if you are a health 
insurance company, you would, if you could cherry-pick, pick 
healthy and not people with other conditions. But it is quite 
the opposite with the flexibility incentives that Medicare 
Advantage has, and I think, Dr. Syed, you talked about that in 
your testimony, and Dr. Batra.
    So you talk about--just kind of reemphasize, given the 
flexibility you have in Medicare Advantage plans to spend money 
on social determinants of health, one, that you are bringing in 
people that are--that have chronic conditions, that are sick. 
And not only are you bringing them into your program, but you 
are giving them far better services than they get in the 
Medicare fee-for-service plans. Could you address that, one, 
that the criticism of cherry-picking, if you do, which I don't 
think that you do, and the other one is how your plans are 
structured that are so much better for people with chronic 
conditions, like Mr. Curtis' bill is trying to allow health 
insurance companies to do with their medical loss ratio 
flexibility.
    So, Dr. Batra, if you would, go first.
    Dr. Batra. Sure. So we serve about 15,000 duals, you know, 
so that tells you, out of a 220,000 population, 15,000 are on a 
fully integrated dual eligible special needs plan.
    We also serve folks who are low-income subsidy folks. We 
serve folks who are in social vulnerability index four and 
five. So we serve all throughout the population.
    If you look at the social HRA that I spoke about, about 10 
to 15 percent of our people have indicated, when we do their 
initial HRAs, that they have food insecure. We have 2 or 3 
percent of people who say they are housing insecure, many 
people who say--who are transportation insecure. So they are 
people from all backgrounds.
    In terms of how we address their needs, it is through our 
supplemental benefits. We offer in-home benefits that include 
meals. We have a third of our population that complains of 
living alone and falling. We have benefits where we send up 
occupational therapists in their homes, so they can help with 
safety and be able to mobilize better within their own home 
setting.
    So those are two very high-level examples. Transportation 
is a big issue if you are an older adult, especially during the 
pandemic, when you wanted to get vaccinated, you wanted to have 
access to that ride that would take you to where you needed to 
get the vaccine. That is the other benefit that we bring 
across.
    Ninety percent of our membership, more or less, use 
medication, and 90 percent of that membership takes a zero-
dollar medication. So that is what we also bring, is that 
affordability to them, so they can really--you know, and those 
are the people who can use that benefit. So we do serve people 
from all walks of life.
    Mr. Guthrie. Thank you.
    And Dr. Syed?
    [Pause.]
    Dr. Syed. Thank you.
    Mr. Guthrie. If you would like to address it--OK, thanks.
    Dr. Syed. Yes. ChenMed goes where the need is. And my 
biggest challenge, ever since I completed residency training, 
has always been access. And I have learned with Medicare 
Advantage that Medicare Advantage opens the door. I mean, I am 
able to give my patients and their families my cell phone 
number. They call me if they are feeling, like my wife likes to 
say, a little icky. And if I need help getting a patient to 
stick to a treatment plan, I am able to call the kids and 
grandkids for backup.
    My team texts my patients daily about health, simple 
messages like reminding them to get a flu shot or staying 
hydrated on a hot summer day. We even call our patients weekly. 
We call them love calls. Even if our patients feel good, they 
make them feel better, just by saying hello. And I am able to 
see my patients at least on a monthly basis. This is how we are 
able to prevent little problems from becoming big ones.
    I--food--when I think about the social determinants, I 
think about food insecurity and----
    Mr. Guthrie. Unfortunately, I only have about 18 seconds 
left.
    Dr. Syed. Oh, sure, sorry.
    Mr. Guthrie. So I apologize.
    Dr. Syed. Sure, sorry.
    Mr. Guthrie. I just wanted to kind of summarize and tie 
this to the legislative hearing that--H.R. 976, giving private 
insurance plans flexibility within their medical loss ratio, 
will allow other plans like Medicare Advantage to social 
determinants of health spending that are important to the 
healthcare, even though it may not be directly to--through 
their healthcare spending, but the things that matter on people 
being healthy. And that is why I think this is an important 
discussion.
    So thank you very much. And I appreciate it, and I yield 
back my time.
    Ms. Eshoo. The gentleman yields back. The Chair now 
recognizes the chairman of the full committee, Mr. Pallone, for 
your 5 minutes of questions.
    Mr. Pallone. Thank you, Chairman Eshoo, and thanks to the 
witnesses for being with us.
    As we know, robust public health data plays a critical role 
in improving public health. And I wanted to start with Dr. 
DeSalvo.
    You have worked firsthand both in the Federal Government 
and in industry on improving the collection and sharing of 
health data, and know well how these investments can help 
improve health outcomes. For example, you played a leading role 
in implementation of the HITECH Act. In your testimony you 
noted that CDC's data modernization initiative would benefit 
from the lessons of HITECH. So let me ask you, can you discuss, 
Doctor, further what lessons learned from HITECH should be 
incorporated into the policies that we are considering to 
improve public health data collection, if you will?
    Dr. DeSalvo. Thank you, Congressman. It is an important 
opportunity for the country to, of course, recognize that we 
have created a digital infrastructure for healthcare. On the 
other hand, we now are about to embark on something like that 
for the public health infrastructure. And I do very much 
appreciate your comments that this could be boring for some 
people, but it is vitally important to the health of our 
communities.
    The specific areas where I think the country learned some 
lessons from the implementation of HITECH include, first, 
around data and standards. That means, as we design the system 
going forward, what we should reflect on is that, rather than 
allowing each information technology system to develop its own 
proprietary standards, its own special way of doing things, we 
should create an open opportunity where there's shared 
standards. There's already--we don't have to invent many of 
those. There's organizations called standards bodies that are 
already working with the CDC and public health officials around 
the country to identify and clarify which standards we can use 
as the foundation, so the building blocks all talk to each 
other, and we start with interoperability as the base case.
    The second is to make certain that we are thinking about 
the uses. What is the end that we have in mind? And, as the 
committee is articulating in a number of the bills, equity has 
to be a part of how we design this system. Yes, we need the 
system to be able to identify infectious diseases, and track on 
communicable disease for communities, but we also need to do 
that in a way that allows us to know where the resources need 
to be applied most. So building into that design, understanding 
of what are data systems that have to tell the story around 
equity, or around important public health challenges like 
maternal mortality.
    The last thing I would say is timing. We pushed out the 
funding for HITECH, and the system stood up. There was some 
training for workforce, but it delayed a little bit behind when 
the systems were actually up and running. And I think what we 
all know is that it takes humans, it takes people to not only 
work those systems but to interpret the data and the public 
health--for the public's health, and work with community 
organizations to put it to good use to make change on the 
ground.
    So we have to make certain that our workforce efforts are 
not only focused on COVID, but thinking more broadly about the 
infrastructure of public health and how to make that a durable, 
longstanding opportunity to make good use of the data to 
improve health and equity in communities.
    Mr. Pallone. Let me ask about resources, because, you know, 
Congress has provided funding for public health data and 
modernization in the CARES Act and Rescue Plan appropriations. 
But these were one-time investments. And you said that health 
departments need stable resources.
    So the LIFT America Act, which was introduced by Energy and 
Commerce Democrats, has this core public health infrastructure 
program to help fund public health needs such as facilities or 
equipment upgrades, workforce capacity, health info systems. 
Can you just comment on this program?
    In your view, what further steps should the Federal 
Government be taking to help improve public health data 
collection?
    Dr. DeSalvo. Well, I--Congressman, I first want to just say 
thank you to Congress for recognizing how important the issue 
is. The public health community, of which I am a member, really 
is appreciative of the opportunity to meet the needs of the 
public.
    However, I think you are raising the important point, that 
it--data doesn't happen in isolation, it requires a system, 
which means we not only need to have strong data systems 
upgrades initially, but they have to be durable and 
sustainable, so that the health departments can refresh the 
computers they have, or the--refresh the IT security systems 
that they have over time. So it is an ongoing commitment that 
they would need to make, to make sure they can meet the 
population's needs.
    They also need workforce, they need partnerships, they need 
basic infrastructure to keep the lights on every day. I mean, 
it is really--would be hard to explain for many people in 
America how underresourced and challenged many health 
departments in America are. I used to say when I was health 
commissioner, we do our work with two nickels and some friends, 
and we are really thankful for a lot of our friends.
    This is an opportunity in this pandemic, a learning moment, 
that we have a critical infrastructure that has been struggling 
to meet the needs of the population's health, is ready to do 
more. And I think, through partnership, we certainly can think 
about investing in the whole system, not just the data systems. 
But I think we are on a good path, as a country.
    Mr. Pallone. All right. Thank you so much.
    Thank you, Madam Chair.
    Ms. Eshoo. The gentleman yields back. The Chair is now 
pleased to recognize the ranking member of the full committee, 
Mrs. McMorris Rodgers.
    You have 5 minutes for your questions.
    Mrs. Rodgers. Thank you, Madam Chair.
    Dr. Syed, we are talking a lot about the need for more 
data. I wanted to ask, based upon your experience working at a 
FQHC and at ChenMed, can you just further elaborate on the role 
of the doctor-patient relationship in addressing social 
determinants of health?
    Dr. Syed. Thank you. It is so important for doctors to know 
about every emergency room visit. I was shocked when, during my 
time at the FQHC, that half of all medical care in the City of 
Tampa was delivered in the emergency room setting, and then 
even further shocked, when I joined ChenMed, that in the United 
States, at least pre-COVID, half of all medical care was 
delivered in the emergency room setting. So doctors must know 
about every emergency room visit. They must know about things 
like when a patient doesn't fill their prescription refill. 
They must know about every referral when the patients are being 
referred to specialists.
    It is so important for doctors to also understand the costs 
of healthcare. You know, doctors should be more concerned about 
the medical complexity of their patient, rather than the 
medical complexity of the charting, which, unfortunately, is 
what we see in the fee-for-service healthcare system.
    Mrs. Rodgers. Thank you.
    Dr. Batra, on Capitol Hill right now there's a number of 
Members, Democrats, that have been promoting the Medicare for 
All proposal. And the effect of Medicare for All would be to 
ban private health insurance plans, including Medicare 
Advantage plans.
    When you look at who is leading the way right now in 
addressing social determinants of health, it is really 
private--it is the private sector--by the work that SCAN is 
doing. I wanted to ask, are there specific programs that you 
would like to highlight, as far as the success that could be 
implemented by employer or individual health insurance plans?
    Dr. Batra. Absolutely. Thank you for giving me the 
opportunity. I think one of the programs that I highlighted, 
I--we call it the peer-to-peer program, and I think that has 
played a key role for us.
    I absolutely agree with Dr. Syed. Physicians are busy, 
physicians really want to build that trust, but we also know 
that trust can be built with peers. So we have been utilizing 
our own members to engage with members in a way they can relate 
to in the way they can empathize, in the way that they can 
understand around barriers that are big for this older adult 
population. Social isolation: 30 percent of our members tell us 
they feel lonely all the times or more than half the time.
    Similarly around incontinence and falls, so our peer-to-
peer program, which extends the reach of the physician team, 
has been able to do that. So I think that is a very key 
program.
    The other program I would quickly like to highlight is our 
community health worker program. If we truly want to address 
health outcomes in an equitable manner, we need to recruit 
people from the community that have the trust of the community, 
that can build on the trust of the community, that can not only 
help them navigate this very complex healthcare system for our 
members but also be able to connect them to community-based 
resources if they are not available, let's say, with an MA 
plan, in terms of benefits and programs.
    We have a very successful program we just published in a 
very well-reputed Journal of Geriatric Society. And that is 
exactly what that program does, is it takes the physician's 
care plan and makes the care plan really happen where the 
patient wants it, in their home setting, in the community 
setting, versus in the ER, in the hospital.
    Mrs. Rodgers. Thank you. Thank you.
    Dr. DeSalvo, the CDC has received over $1 billion from 
COVID relief packages to update, modernize public health 
infrastructure at the State, local, and Federal level. I wanted 
to ask, what are the metrics that you would recommend that we 
use to determine whether or not those dollars are being spent 
wisely and driving results?
    Dr. DeSalvo. Congresswoman, thank you for the question. And 
I think we can learn a lot from what has already worked on the 
ground. I will begin there.
    In States like Washington State, particularly a community 
like Spokane, that has a lot of historic work that it has done 
in partnership with community to address the public's health--
it was one of our Public Health 3.0 communities that I visited 
when I was in the administration, and learned from--and what 
you learn from that is begin with the end in mind.
    And as a country, if we want to address inequities in top 
public health issues, there are bills before us today, for 
example, about maternal mortality and the disparities in it for 
Black women, in particular. We could begin with what--we call 
that--and then work backwards, and say--then we need data that 
is going to inform actions at the community level to drive 
change.
    I will particularly call out, though, I think the 
importance of what was asked for in the data modernization 
initiative by Congress, and that was for CDC to develop a 
strategic plan, and because that will be essential to have 
clarity about what needs to happen by when and by whom. Those 
are the use cases. And then, rather than just collecting data 
for data's sake, it must be done with the intention of 
improving the public's health, going forward. So a strategic 
plan, led by CDC, which is called for.
    And I think, in addition, I would just call out Congressman 
Burgess' bill to think about what is already happening at HHS, 
and this opportunity to do an assessment inside of the 
government of what are the levers that could be used. Once we 
understand from the data the challenges that need to be solved, 
how can we act on that to improve health equitably and address 
social determinants, because there are many--probably already 
underway, and it would be good to not be duplicative, but to 
make sure that we are being as efficient as possible, because 
the public is counting on it.
    Ms. Eshoo. The gentlewoman's time----
    Mrs. Rodgers. Thank you all.
    I yield back.
    Ms. Eshoo [continuing]. Has expired. It is a pleasure to 
recognize the gentlewoman from California, Ms. Matsui, for your 
5 minutes of questions.
    Ms. Matsui. Thank you very much, Madam Chair, and I--this 
is a terribly important hearing we have today, with much 
legislation.
    You know, last week we examined the importance of 
increasing vaccinations to improve public health. And I would 
ask the witnessed how we can help providers and public health 
systems modernize Immunization Information Systems to help 
support this goal.
    And may I say this? Public health is so important. Public 
health involves the whole community. It involves people who 
don't have access easily to health systems. And I really feel--
I have got a huge health system in my district, four major 
hospital systems. I really--I also have a great string of 
community health centers too. And I really have a wonderful 
public health center too. But I must say this, that we have not 
funded public health in the way we should be. And I think every 
time we get some sort of pandemic or some sort of crisis, we go 
back again and say, well, this is what we should have been 
doing. We can't do that any longer.
    So I really feel hearings like this are so important 
because, you know, we look at the social determinants data, and 
that exacerbates health disparities. And the bills today we are 
examining can provide a range of solutions to capture these 
central data that is important to ensure that people don't fall 
through the cracks as they did this time, as we promote health 
and mitigate disparities beyond healthcare, including access to 
healthy food, education, housing, and transportation.
    So I am really interested in exploring how we can 
strengthen public health reporting by leveraging both clinical 
and public health data. And a lot of this data is not just in 
the health arena, either, it is in schools and education 
systems. It is in--just as somebody said before, just listening 
to people, encouraging conversation. Those kinds of data are 
really important to actually understand fully what is 
happening.
    Ms. Blauer, you highlighted the need for robust data 
collection and reporting systems at the local and State levels. 
And this on-the-ground expertise is really important. So, as we 
build out our health data utility infrastructure, how can we 
coordinate more on the State-level health information exchanges 
and other clinical data sources?
    I know there is a lot of conversation that goes on with our 
community health centers and the public health area, but how 
can we facilitate this even more, so that it goes up--so that 
we can actually capture the data, understand what is happening 
throughout not only the State itself but throughout the 
regions?
    Ms. Blauer?
    Ms. Blauer. Thank you, Congresswoman, for the question.
    There are--one of the things I have learned in my 
experience in the public service is that there are some of the 
most important thinkers and subject matter experts across the 
board in government. We have some of the smartest thinkers, but 
we need to invest in the skills of subject matter experts to 
actually use data to solve hard problems.
    So there is one part where--we need to start investing in 
the capacity of people who are actually charged with leading 
programs on how they can use data.
    The health information exchanges are also incredibly rich 
resources that exist that have great data and great data 
skills, but there is a disconnect between the exchanges and 
those people on the ground who are responsible for delivering 
programs. And so we need to start thinking about how can we 
build the capacity so that we are scoping our problems, that we 
are thinking about our problems in a way that elicit the right 
kinds of data responses, and that we have the skills to 
actually take that data and apply it to solutioning.
    Ms. Matsui. OK, well, thank you.
    Dr. DeSalvo, we are talking about structural racism here. 
It is a public health crisis. And I thank you for drawing 
attention to this in your testimony. This was a huge issue 
after Hurricane Katrina. And 15 years later, what has the COVID 
pandemic revealed about the structural racism in the digital 
infrastructure?
    Dr. DeSalvo. Thank you for raising the issue. It has been 
such an important conversation in the pandemic. But as you say, 
it is not a new conversation in many circles. We saw it very 
clearly after Hurricane Katrina. I saw it personally, as I was 
on the streets delivering care to people, that where you live 
matters so much.
    It was described by another witness: a 25-year gap in life 
expectancy in New Orleans, a whole generation, based upon where 
people live. And where people live is not just about a choice, 
it is also about structural systems that cause redlining and 
other factors that make a difference in the access you have to 
food and education and economic opportunity.
    It has really motivated many of us in public health to 
focus on this as a public health issue. In fact, in a recent 
National Academy of Medicine report I had the chance to 
coauthor with Bob Hughes from Missouri, we talked specifically 
about how, coming out of the pandemic, equity and racism will 
have to be priorities for public health and that the data 
systems that are built will have to be capable of providing 
information not only about individuals and how their health is 
different--predicated on things like the color of their skin, 
or race and ethnicity--but also, what are the structural 
systems supporting them? What are the school food programs? 
What is the access to sidewalks, so kids can walk to school?
    So it is a double-layer system, not just--that looks at 
people, but also at the context in which they live.
    Ms. Matsui. So thank you very much. I have gone way over my 
time. And thank you very much for your testimony.
    And thank you, Madam Chair, and I yield back.
    Ms. Eshoo. he gentlewoman yields back. It is a pleasure to 
recognize the gentleman from Michigan, Mr. Upton, for your 5 
minutes of questions.
    Mr. Upton. Well, thank you, Madam Chair. Thanks for this 
hearing today.
    The ability to access and use information is certainly 
critical to many aspects of healthcare and health system 
operations. And the further embrace of real-world data and 
evidence, including SDOH data, can all help improve the facets 
on healthcare.
    The 21st Century Cures Act included provisions to improve 
data sharing through reforms to the statute created by the 
HITECH Act that established the Office of the National 
Coordinator, ONC. However, as we know, this issue is bigger 
than ONC. How we use the data today is negatively impacted by a 
number of things, including how we regulate data use, or how 
capable the agencies of HHS are using the data well.
    Representative DeGette and I released a discussion draft 
earlier this week that we are calling Cures 2.0 to help solve 
some of the issues that we are discussing. I would like to 
focus on two of those provisions.
    Ms. Blauer, section 304 of Cures 2.0, entitled ``Increasing 
Use of RWE,'' builds on FDA's efforts by requiring HHS to 
outline approaches to maximize and expand the use of RWE, and 
establish a task force to develop recommendations on ways to 
encourage patients to engage in RW data generation. So as we 
consider ways to improve data access and use--in use for many 
in health, how important is the patient participation in data 
access for the FDA or other healthcare operations?
    Ms. Blauer. Thank you, sir, for your question.
    So I want to start by saying that I think a lot about 
resident engagement and patient engagement in data across the 
board. I think we need to be incredibly comprehensive as we 
think about how we reflect the realities of life in a way that 
we collect data, and patient information is at the center of 
that consideration.
    So we have to, obviously, make sure that we include all of 
the protections and the privacy and advocacy that is required 
to keep people's personal information safe, and make sure that 
they are informed significantly in order for the safe 
collection of that qualitative contribution to data collection, 
but also to really understand why it is important to have 
individual information as part of a consideration for data 
collection.
    Mr. Upton. Thank you.
    Dr. Walker and DeSalvo, my staff over the years has 
communicated with CMS and other agencies about the current 
capabilities of their computer systems. Generally speaking, the 
feedback has not been terrific.
    One provision of Cures 2.0 would begin the process of 
Congress working with HHS to update CMS and other computer 
systems with the goal of helping these agencies use the data 
better. So as we consider the bills before us today, I am 
curious to your thoughts on whether improving CMS data 
capabilities through modern computing approaches can help 
support our goals.
    [Pause.]
    Dr. Walker. Thank you. I will go first, and I really 
appreciate the opportunity.
    From a State perspective, we certainly would appreciate 
having additional support for CMS to update systems, to allow 
for us to work together as States try to engage and leverage 
data that is available. I think, as we learn more about the 
impacts of social determinants of health, there are models that 
can test how we support payment strategies and delivery system 
innovation.
    For example, the CMMI's Integrated Care for Kids model and 
the maternal opioid use model, as well as other programs like 
Medicaid waivers, really allow you to look at how you are 
investing in the earliest years of life. But the challenge is 
understanding what is working, and you need data to do that 
programmatic evaluation and assessment.
    We know, at Nemours, as we try to deploy value-based 
services and new types of care delivery, we absolutely need 
opportunities to work with CMS to develop demonstration models 
to invest in the data and really figure out how to implement 
value-based care.
    Dr. DeSalvo. I will just maybe add a related issue, if I 
could, Congressman, which is to--first of all, I am not an 
expert in the CMS data systems, though my appreciation is that 
they are in need of some upgrade. And I think, as Dr. Odom 
Walker is describing, that opportunity there has to do with 
making sure that we can meet the needs of the population's 
health, using data that can support value-based care models or 
global health models.
    But I particularly wanted to call out that in Cures 1 there 
was a push towards open APIs, FHIR-based systems, which I know 
you and your team are familiar with, those same models can be 
applied to public health. And as we think about modernizing the 
public health data infrastructure, and because of 21st Century 
Cures, there has been a movement in the field with public 
health and the digital world to create that kind of an 
interoperable system, so we don't repeat any of the mistakes 
the country made with HITECH. So thank you for that direction 
envisioning.
    Ms. Eshoo. The gentleman's time has expired, and I thank 
him.
    It is a pleasure to recognize the gentlewoman from Florida, 
Ms. Castor, for your 5 minutes.
    And I want to remind Members that questions are being--
those that are--I am sorry. We are calling on Members in the 
order of subcommittee seniority, OK? Just as a reminder.
    Ms. Castor, you are on.
    Ms. Castor. Right. Thank you very much, Madam Chair. Thank 
you for calling this very important hearing, and thank you for 
including my bill with Congresswoman Underwood, the Ensuring 
Transparent, Honest Information on COVID Act, the ETHIC Act.
    Colleagues, this committee, Democrats and Republicans, have 
really shined the light on the lack of transparency and the 
consistency around COVID-19 data during the pandemic. And I 
think there are three main issues: one, many local communities 
and States did not have the modern data reporting systems in 
place; two, there was a troubling pattern in a number of places 
of withholding COVID-19 data, censoring of data, whether it is 
nursing home infections and deaths or overall mortality rates, 
or testing, very serious issues there; and then three, of 
course, we don't have the Democrat--demographic data we need on 
health disparities, and we are--we have to do better on that.
    Communities, businesses, public health experts need this 
consistent and transparent health information to help keep 
families safe, and to implement effective measures, and do it 
efficiently.
    So through the bipartisan--as Chairman Pallone said, 
through the bipartisan emergency relief packages, this 
committee really helped direct huge new investments in--to 
update data reporting at the CDC. But we are going to need to 
provide additional direction. And in addition to the bills that 
get to it through standards, which is very important, the ETHIC 
Act also will do this through transparency and data reporting.
    One, it will require States, local communities, Tribal and 
Territorial governments to report COVID-19 data, including 
demographic information to the CDC; and two, make sure that it 
is all reported up to the public.
    And then, too, we are going to--we need to tap the 
expertise of the National Academy of Sciences Engineering and 
Medicine to review the current system and provide us with 
additional recommendations on public health data, 
infrastructure, and reporting.
    So for Ms. Blauer, thank you so much for your longtime and 
very important work to improve health outcomes using data, but 
especially for your work and that of Johns Hopkins, the 
Coronavirus Resource Center, over the last year. In your 
testimony you say that consistency across States is going to be 
vitally important. You highlight the ETHIC Act--thank you very 
much--but can you also talk about how--what do you see that we 
need to do to ensure dependable, transparent data for the 
public, for communities, for businesses going forward?
    What else do we need to be doing?
    Ms. Blauer. Thank you, Congresswoman, for the question. I 
can say with great authority that there is a hunger at the 
State and local levels for standards, for this common language 
that actually can help guide the way that we collect and think 
about data across our States and our cities.
    We had, over the course of our managing the Coronavirus 
Resource Center, daily calls with mayors, with Governors, with 
people from local communities, from health departments that 
were seeking advice on how they should collect this data, how 
they should express this data to the public, how they should be 
thinking about letting this data support their decision making, 
and they were searching for support and validation of their 
approaches.
    So, again, while the systems that collected this data were 
often shoestring operations in some cases, started with manual 
collections that did mature over time, I think the reality is 
that these organizations across the board in State and local 
communities were really seeking that kind of high-level 
validation that what they were collecting and how they were 
using this data was the right path forward.
    And they also wanted to be able to look at their neighbors 
and say, ``I see that you are having better experience in 
managing this part of the pandemic. I want to learn from you.'' 
And with--in the absence of those standards and that common 
language, it became very difficult to do apples-to-apples 
comparison across the geographies.
    And so the role of Federal Government here could really be 
let's create that common language, let's provide those 
standards, and then let's provide the support for the State and 
local communities who are going to be navigating these health 
challenges in a way that they can learn from each other, they 
can learn from their wins, they can learn from their failures, 
but then they can also think really critically about how they 
are applying that data to the policy levers that have been so 
critical to the way we have navigated the pandemic. Thank you 
again.
    Ms. Castor. Thank you very much.
    And I yield back.
    Ms. Eshoo. The gentlewoman yields back. It is a pleasure to 
recognize the gentleman from Virginia, Mr. Griffith.
    Mr. Griffith. Thank you very much, Madam Chair. I am very 
happy to follow Congresswoman Castor talking about ensuring 
transparent, honest information on COVID-19.
    Ms. DeSalvo, it is being reported that there are financial 
ties between Google and EcoHealth Alliance, a company that was 
collaborating with the Wuhan Institute of Virology to conduct 
bat coronavirus and other virus research. As donors to 
EcoHealth Alliance, do you support its lack of cooperation with 
my request and the requests of other members of this committee 
as we seek information about the origins of COVID-19?
    Dr. DeSalvo. I appreciate the question, Congressman. I 
don't have all the details of that report, but I believe the 
reporting has been inaccurate. The one-off grants that were 
received by that researcher were years ago and predate the 
pandemic. So my appreciation is they are not related.
    Mr. Griffith. Well, and they certainly predate the 
pandemic, as far as the base research. But the data indicates 
that there was a 2010 study on that bat flaviviruses that was 
listed as being supported by Google. There is also a 2014 study 
on--if I am pronouncing it correct--henipavirus, which infects 
fruit bats and micro bats. And that was in--on the spillover. 
And then a 2018 EcoHealth Alliance paper entitled, ``Serologic 
and Behavioral Risk Survey of Workers with Wildlife Contact in 
China.'' That was made possible with the contributions of 
Google.
    So it is--it clearly predates the coronavirus outbreak, but 
this research has been going on for over a decade. And the real 
question is, does Google support or condemn EcoHealth Alliance 
that they donate to?
    Do they support or condemn the stonewalling of Members of 
Congress who are trying to get information about what happened 
with COVID-19, and what the origins really are, whether it was 
a wet market situation or was it a lab leak?
    Dr. DeSalvo. With respect to the--to this particular 
investigator, or set of investigators, as I said, I haven't 
seen the reports, and I am not intimately familiar with the 
work.
    What I can submit to you is that we will work with you and 
your office and come back with answers that you may have--and 
see that we have the right people who have more intimate 
knowledge of the situation.
    Mr. Griffith. And I appreciate that. I would also 
appreciate any conversations, emails, et cetera, that Google 
may have had from EcoHealth Alliance that may have indicated to 
them information about COVID-19, since you all were involved in 
earlier studies related to bat viruses that Mr. Daszak of 
EcoHealth Alliance was one of the authors of, saying that this 
was clearly coming from wet markets and from bats, and you all 
were involved in that. Any conversations you all might have had 
in 2019, 2020, or 2021 regarding that, if you could get me that 
information, that would be greatly appreciated. And can you 
commit to working with us to get that information?
    Dr. DeSalvo. I certainly commit to working with you all, 
and I will have the right people follow up with your office.
    Mr. Griffith. I appreciate that greatly. You know, it is 
important that, as we talk about having an honest and 
transparent discussion about these items, that we move forward 
working together. And is Google prepared--because it has been 
criticized in the past for failing to demonstrate a commitment 
to fostering open debate on scientific issues such as this--is 
Google prepared to commit to such an open debate?
    Dr. DeSalvo. I tell you, Congressman, I very much 
appreciate you asking that, because, as a physician, the debate 
about the medical treatments and origins and even the diagnosis 
of COVID has been a rich and complex environment for the past 
year and a half, and not only for the medical community and the 
public health community, but the community at large has been 
involved in trying to understand, as we learn on the journey, 
what works, what doesn't work, how should we be protecting 
people in communities, how should we treat our patients in the 
hospital or at home.
    So as that information has evolved, we have relied on 
trusted authorities like the CDC or the World Health 
Organization outside of the U.S. to provide authoritative 
content, so we can lean on the group of scientists that build 
consensus statements from those authoritative groups. And then 
we use that to inform policies that we apply to information, 
not only to raise up important quality information that we want 
people to have, people--to protect themselves and their 
families, but also----
    Mr. Griffith. Yes, ma'am.
    Dr. DeSalvo [continuing]. Harmful misinformation.
    Mr. Griffith. And I appreciate that. And I think we should 
go forward working together. And I hope that Google will have 
an open policy on scientific discussion, because the EcoHealth 
president has recently been taken off of or left the WHO study, 
and it is now becoming clear that they are somehow involved. We 
don't know exactly how, because they are stonewalling us. And 
all we want here are answers to the American people.
    I yield back.
    Ms. Eshoo. The gentleman yields back. It is a pleasure to 
recognize the gentleman from Vermont, Mr. Welch, for his 5 
minutes of questions.
    Mr. Welch. Thank you very much. I want to thank all the 
witnesses for being here. And I want to bring up Congresswoman 
Bustos' Social Determinants Accelerator Act, and I am a 
cosponsor, and it is really important in Vermont.
    In--the Vermont housing needs assessment in 2020 showed 
that more than 19,000 Vermont households face housing quality 
issues. It includes homes with coal or limited heating sources, 
40-year-old mobile homes, incomplete plumbing, and so on. And, 
unfortunately, too many Vermonters do live in these conditions.
    Dr. Walker, you mentioned the Social Determinants 
Accelerator Act in your testimony. And the bill, as you know, 
would create a program at CMS to provide grants to State and 
local governments to develop plans to combat social 
determinants of health that are resulting in negative health 
outcomes. The--are you aware of any cities or States who have 
developed a strong model to improve housing and health outcomes 
at the same time?
    Dr. Walker. Thank you, Congressman. I think there are a 
variety of examples that are critically important, not only 
around housing, but also around nonmedical transportation, 
home-delivered meals, and educational services. And some States 
have incorporated waivers into their Medicaid program. I think 
a few examples exist, including North Carolina, where they are 
incorporating this into their value-based payment. Maryland is 
certainly implementing a program to support individuals with 
developmental disabilities. And there are others--Minnesota's 
waiver that looks at the provision of housing stabilization for 
individuals who are at risk for homelessness.
    I think using these examples and innovations are helpful. 
They also allow us to invest in families with long-term impacts 
on the health and wellness and mental health and well-being of 
children and adolescents. And so having these examples is 
helpful, but encouraging it across our Nation could be a 
tremendous health impact.
    Mr. Welch. Thank you, Dr. Walker.
    And Dr. DeSalvo, you also discussed the need to address 
social determinants of health, housing being one of them. How 
can investment in updated health data systems, including the 
use of qualitative data, which you mentioned, help improve 
public health and build up our communities suffering from 
systemic health inequalities?
    Dr. DeSalvo. Thank you, Congressman, for the question, and 
I will answer it. I do want to first give a shout-out to 
Vermont, who has done some great work, particularly for 
populations with substance use disorder, in understanding how 
to blend and grade resources to address social determinants of 
health, including housing--housing being, for people, probably 
the most important social determinant of health. We saw that 
firsthand after Katrina, and we see that every day in 
communities. So I also appreciate you raising a really 
important foundational structure for individuals.
    Two particular points. One is that data is--has to be 
timely, actionable, and granular. It has to be not only 
quantitative, because you need anonymous population-level 
information that you can map to direct intervention, but you 
also need the voice of community. Some of the bills today 
include that concept, that there have to be community advisory 
voices, particularly those bills--the bill about maternal child 
health.
    But that is true in every context. And that can be done 
manually, if you will, human to human, and that is important. 
It can be augmented by additional data sources. I mentioned 
information that Google has made available to public health on 
the open repository, including search symptoms trends. Again, 
this is anonymized data that is at the population level that 
could be useful to augment that important data that public 
health needs to take action.
    Final point, these bills, many of them speak to this idea 
of community collaboration and partnership. I think you will 
find threads throughout many of the successful projects in 
communities that it is really about everyone coming together to 
create the conditions for health, not any one sector alone. So 
public health with business, faith-based and others.
    I will just--for your information, and for your staff, 
particularly, the NASDOH, the National Alliance for the Social 
Determinants of Health, has a report on their website that 
talks about some great examples across the country and a 
playbook for how communities can do this, including what the 
data needs might be.
    Mr. Welch. Thank you very much.
    Madam Chair, I yield back.
    Ms. Eshoo. The gentleman yields back. The Chair is now 
pleased to recognize Dr. Bucshon from Indiana for your 5 
minutes of questions.
    Mr. Bucshon. Thank you, Madam Chairwoman, and thank you for 
having this hearing. This is really important.
    Social determinants of health are critical in today's 
healthcare system to improving health outcomes and better 
understanding why social situations that people in our society 
are in actually have a substantial effect on their ability to 
lead healthy lives and to get good outcomes.
    But it is a very complicated subject. I have worked on--a 
lot on maternal mortality and maternal health. And, you know, 
we have had testimony from physicians from Parkland Hospital in 
Dallas, for example, which--that is a public hospital for the 
underserved, and many of their patients are on Medicaid, and 
their health outcomes were outstanding as it relates to 
maternal health. And then we heard testimony from other areas 
of the country that also service underprivileged and primarily 
Medicaid patients, where their data wasn't quite as good.
    So we really need to know why this is, and why that--and I 
think part of that is because Parkland Hospital has data-driven 
protocols to how they take care of patients, at least in the 
maternal health. But this is also across our healthcare system.
    It is all about innovation, I think, in healthcare. 
Innovation and better-collected data help promote a more value-
based system that, in my view, helps lead to better outcomes, 
because we are able to determine why the outcomes are poor in 
one area that serves a similar population but outstanding in 
another area of our society.
    One area I want to focus on was the provider's role in 
gathering and collecting of data. As we know, doctor burnout is 
at an all-time high. Most of the time, the main reason, in my 
view, for this is due to the burdensome paperwork and 
duplicative administrative tasks that a lot of physicians don't 
feel they signed up for. They want to take care of people. All 
of this has doctors spending more time doing paperwork and less 
time with their patients. While I think data is important and 
should be incentivized, I am cautious not to put more of a 
burden on doctors and other providers who already need more 
time with their patients.
    In that vein, Dr. Syed, it is my understanding that there 
are existing ICD-10 codes for social determinants of health 
that most doctors aren't collecting at the moment. In order to 
properly advance social determinants of health policies, 
someone will have to be responsible for reporting the data 
collected. In your experience, who is responsible for 
collecting the data needed for better social determinants of 
health?
    And whose responsibility would it be if some of these bills 
considered today would become law?
    Dr. Syed. Thank you. In my past life at the--in the FQHC 
world, it was in the fee-for-service system. It wasn't in a 
value-based system like I am currently in with Medicare 
Advantage. So I was forced to focus on sick care. I have always 
felt like I was two steps behind. I remember I was always 
reacting to problems that were already out of control. See, in 
the Medicare Advantage environment, practicing preventive 
medicine keeps all of us--not only the doctors, the nurses, all 
of our care team members--many steps ahead. And that is when 
you are able to notice the small changes before they really 
become the big ones.
    So it should be the primary care doctor being at the center 
of the care delivery system.
    Mr. Bucshon. Yes, well, I appreciate that, and I think, you 
know, that does add some administrative burden. But I do agree 
that there has to be someone--the primary care doctor, you 
know, is kind of the captain of the ship. And so I just want to 
make sure whatever we do doesn't unnecessarily burden 
providers.
    And so I want to talk a little bit more about your 
experience with--in Medicare Advantage. Why do you think it is 
more of the--that more of the Federal Government and State 
governments are so hesitant to embrace the existing approach 
that gives plans and providers a risk-adjusted amount of money 
that lets them decide which social determinate interventions 
need to take place without adding more burden-inducing 
reporting and box checking?
    Because what you just described sounds better to me than 
maybe the system that you had experience with before.
    Dr. Syed. Well, sure. I mean, all of us got into medicine 
to help people. None of us thought that we would be getting 
into healthcare and spend hours every day focused about the 
documentation required for reimbursement.
    So what I would like to see is, really, more education 
about Medicare Advantage, because our current system is based 
on sick care rather than primary care. You see, with the 
Medicare Advantage model, it puts the primary care doctors at 
the very center of the entire care delivery system. You see, 
then the doctor has the time to look into the causes of the 
causes, and then you get to know the patients better than any 
other random doctor.
    I think what you mentioned about the choice, patients 
should be able to go to any doctor they want whenever they 
want. And it sounds great in theory, but when your health is on 
the line, you really want a referral from the doctor who knows 
you the best, the one that you trust the most. And with the 
Medicare Advantage world, yes, I just want to say that, that it 
gives me the time to establish the trust with my patients and 
make the same referrals I would for my mom or my dad.
    Ms. Eshoo. I hate to interrupt----
    Mr. Bucshon. Thank you for that information, and I yield 
back.
    Ms. Eshoo. Thank you. Thank you very much, Doctor. It is a 
pleasure to recognize the gentleman from Oregon, Mr. Schrader, 
for your 5 minutes of questions.
    Mr. Schrader. Thank you very much, Madam Chair, I 
appreciate it.
    I, too, am a supporter and cosponsor of Ms. Bustos' bill on 
the Social Determinants Accelerator Act, and I think it is very 
important to have that coordination. We have heard here today 
from our witnesses and others that, without that coordination, 
it is very difficult to get things done.
    And in my home State of Oregon, one of the big projects 
that has worked extremely well is our coordinated care 
organizations to deliver Medicaid or Oregon Health Plan 
benefits for a lot of folks. And they are grown up from the 
ground up. It is not something that is put top-down from 
Washington, DC. And it actually has those social determinants 
worked on by the community organizations that know that 
community best, and I think that is what Dr. Bucshon was 
alluding to, and I would agree with him.
    We shouldn't be managing counting different things that 
should be about providing quality healthcare. Dr. Syed, I 
think, hit the nail on the head in his comments and responses 
there. I think it is just so important to coordinate this sort 
of thing.
    Dr. Blauer, with the interagency council suggested in the 
Bustos bill, how do you see that getting out best practices 
like we have in Oregon to folks around the country?
    Ms. Blauer. Thank you, Congressman, for the question. I 
think the most important thing is that, oftentimes, 
particularly when we talk about data or IT infrastructure, our 
gut is to put data and IT folks on these interagency 
committees. And what we need are subject matter experts who are 
knowledgeable about the impacts of program decision making and 
the realities of program delivery on the ground.
    So I think, first and foremost, you need to make sure that 
they are staffed with people who have deep, programmatic 
expertise and who understand what the objectives of the work 
are and understand how they can leverage tools and technology 
to actually do the delivery of the services and to support the 
work of the committee. So subject matter expertise, absolutely.
    And then prioritization. We need leadership that actually 
can lead with prioritization. We will end up in a boil-the-
ocean moment if we don't have clear goals that are articulated 
and measurable and that we can focus our work collectively on. 
There is a lot of work to be done, and without that kind of 
direction that will allow for us to have those sort of clear 
priorities outlined, we are going to be in a situation where we 
are going to get overwhelmed very quickly. And governance 
allows you to create prioritization with the inputs of that 
subject matter expertise. Thank you.
    Mr. Schrader. Very good. Thank you. Thank you.
    Dr. Syed, you talked about being fully capitated. Fully--
that that makes a difference. What is your definition of fully 
capitated to make the Medicare Advantage system work, in your 
eyes?
    Dr. Syed. It is a model of--especially with primary care, 
where the doctors are not concerned about generating revenue by 
billing. Being fully capitated, we take on the full 
responsibility of the total health of the patient. And so it 
gives us the flexibility to treat seniors with multiple chronic 
medical issues according to their actual individual situations.
    Mr. Schrader. I agree with that, and I think that is--
points to Dr. Bucshon's concern about it shouldn't be the M.D. 
that has to worry about counting all the widgets and worrying 
about reimbursement. If you have a coordinated care group like 
we have in Oregon, that organization deals with that and 
decides, along with the physicians, with the hospitals, with 
the mental health providers, with the pharmacies, about who is 
getting what amount of money based on those local needs.
    I don't see why we don't even just transition to that. Fee-
for-service is so outmoded. I have remote parts of my district, 
very rural parts, that are part of coordinated care districts 
that provide much better health service tailored to those 
individuals.
    Dr. Walker, I appreciate you mentioning the value-based 
payments, you know, as we just discussed here. Were--what 
policy should we be pursuing to foster growth in that arena?
    We are actually trying to do that--Mr. Guthrie, Mr. Mullin, 
and I--with regard to pharmaceuticals. But I think it, 
obviously, applies here, in terms of just care delivery. What 
should we be doing to foster growth in that area?
    Dr. Walker. Thank you, Congressman, for the question. I 
think it is essential, as some of the bills indicate, that we 
need to incorporate incentives, expertise, and make sure that 
States have the bandwidth to move forward with value-based 
payment. That often can start with Medicaid but go beyond, once 
you learn the lessons. Medicare Advantage is fully taking on 
this value-based payment role.
    But it does take a bit of guidance. And, you know, the 
Caring for Social Determinants Act does include a 
recommendation to include the updated guidance to allow for 
innovations like the CCOs to flourish in other places. But it 
does take leadership, it takes alignment, and it takes the 
right expertise. That is where, you know, having data to look 
at the alignment of incentives can be incredibly helpful too.
    Mr. Schrader. Very good, thank you. Thank you all for your 
work.
    And I yield back, Madam Chair.
    Ms. Eshoo. The gentleman yields back. It is a pleasure for 
the Chair to recognize the gentleman from Oklahoma, Mr. Mullin, 
for your 5 minutes of questions.
    Mr. Mullin. Madam Chair, thank you so much. Thank you for 
putting this hearing together.
    Dr. DeSavio--I hope I am saying that right. If I am not, 
please correct me. I--based on your experience in public as a 
public official, can you kind of speak to the importance of 
aligning Federal programs to address the social determinants of 
health?
    Dr. DeSalvo. Thank you, Congressman. On behalf of my 
husband's family, I will say it is DeSalvo.
    Mr. Mullin. DeSalvo, thank you.
    Dr. DeSalvo. You know, Congressman, in Oklahoma you have an 
incredible example of how a group of primary care clinicians 
came together to create an information exchange--this is My 
Healthy Data--and built a global population health model like 
we were just describing, to really allow the docs to care about 
the patients, and then the data gets collected around them, and 
the patients--that data now tells the story of a community's 
health, as well.
    So it is informing public health action. It is a wonderful 
example of how Federal action to spur the innovation and models 
of primary care, of health information exchange can then also 
not only improve the care of patients but begin to tell a story 
and--or improve the care of populations that--that group, for 
example, has done incredible work in COVID, creating dashboards 
that can help the community understand--I believe you had the 
opportunity to see some of those. So----
    Mr. Mullin. I have.
    Dr. DeSalvo. You know, I think it is a wonderful, also, 
example of how the foundation of electronic health record 
information that--primarily for the use of individuals, when 
anonymized, can be useful to help understand the health of a 
whole community. And it is the kind of innovation that we could 
spur or scale across the country and shorten the timeline to 
being able to do good work.
    What is great about that particular effort, by the way, is 
that it is transparent. The docs have a lot of say in the data 
and how it is used, but also it helps to build a virtuous cycle 
of improving the quality of care and, as I said, improving the 
health of the population.
    Mr. Mullin. Are there any examples, like, in your 
experience that you can use to kind of highlight on how this 
has been working?
    Dr. DeSalvo. Definitely. I think, in addition to the 
example in My Healthy Data, there's a couple of States that 
have been leaders in this area of using existing data that was 
built on a foundation, often from a Federal program, and then 
gets expanded.
    I will call out another primary care example, one called 
Macroscope, which was built in New York City by the public 
health department using data from their primary care clinics, a 
similar idea. We already have data. Let's not repeat the 
collection. Let's be efficient. Let's anonymize it and use it 
as a way to understand what are the rates of diabetes and high 
blood pressure in our community. And it is a pretty timely, 
actionable, granular set of data that public health now can use 
to target interventions, to address inequities, to address the 
social determinants of health.
    I could go on a long list, Congressman, but I think what I 
would love for the committee and for others to know is 
innovation in--between public-private partnerships, community 
led, on the ground is happening all over America. I visited so 
many in the course of my career. We have written about them in 
Public Health 3.0 and the National Academy of Medicine report I 
referred to earlier that we just recently put out on public 
health. So we have a sense of what works and we have a sense 
also of what works from the data.
    Now what we need to do is make sure that we have got 
strategy and prioritization and direction, but also fill gaps 
in the data layers and make sure that that data layer is 
interoperable and can help us address inequities.
    Mr. Mullin. Well, that actually leads me right into my next 
question, which was going to be: What can Congress do to kind 
of help--easier for private sector and nonprofits to work 
together on various funding streams to coordinate in this way?
    Dr. DeSalvo. This is an interesting and complex area. One 
of the calls that comes from community often is, when they 
create collaborations they want to not only share governance 
and data, but they want to be able to pool or share resources. 
And there are actually--there is more latitude, probably, than 
many communities realize. Communities like Oregon, or Rhode 
Island, Vermont have found ways to blend and braid funding to 
support particularly low-income populations and address social 
determinants.
    But I will tell you what, I have done that on the other 
end, when I was health commissioner addressing needs of youth 
and violence. It is very hard to blend and braid funds 
sometimes. So I think some of the considerations in the bills--
for example, these interagency councils--could be to catalog or 
understand what are the flexibilities that communities could 
use to not only blend and braid the public-sector dollars, but 
how can the private sector contribute in a way that is again, 
transparent, shared governance, and shared accountability for 
the outcomes.
    Mr. Mullin. Doctor, thank you so much.
    And Madam Chair, I will yield back the remainder of my 
time. I want to thank you again for putting this together, 
though. This is vitally important to a lot of our communities, 
especially the rural parts of the country.
    Ms. Eshoo. It is, and you asked wonderful questions. Thank 
you.
    The gentleman yields back. The Chair now has the pleasure 
of recognizing Mr. Cardenas from California for your 5 minutes 
of questions.
    Mr. Cardenas. Thank you, Madam Chairwoman, and also thank 
you, Ranking Member Guthrie, for having this very, very 
important hearing. And I always appreciate all of our experts 
coming to educate us policymakers so that we make sure that we 
can do the best job we can to serve our country. And we are up 
here on a 30,000-foot level, and you are there on the ground. 
So thank you so much for all of your expertise and your 
wonderful insight.
    Also, Chair and Ranking Member, thank you so much for 
putting H.R. 3969 on the agenda today, as well. I am chairing 
that bill with Representative Curtis, and I appreciate it being 
in the hearing today. This bill would include spending on 
activities related to social determinants of health, and the 
calculation of private health insurance plans and medical loss 
ratio.
    In introducing this legislation, we recognize that social 
determinants of health like reliable transportation, 
availability of nutritious food, safe housing are all primary 
drivers of health outcomes. And to achieve health justice and 
equality for all, we must be more intentional about how we 
address their impact in all parts of our healthcare ecosystem.
    Dr. Batra, in your testimony you discussed the Senior Care 
Action Network, SCAN, the approach to addressing social 
determinants of health. Could you please talk about the impact 
of this approach on members in your network?
    Dr. Batra. Absolutely. I think we started off by making 
sure we collect data the way the members want the total data to 
be reported, how they identify. So for us, having the data 
around race and language was very important.
    Similarly, we have collected years' worth of data on our 
members around their social needs, their transportation, food 
insecurity, loneliness, in-home caregiving and support, hearing 
dysfunction. And we have really used that data to help identify 
members and even connect them to the right benefits and the 
right programs.
    So, for example, 70 percent of our population suffers from 
hearing dysfunction, which, as you know, can interfere with so 
many different things, lead to isolation, lead to loneliness, 
also lead to poor health outcomes. We have hearing aids as one 
of our supplemental benefits. So we try and engage with members 
and connect them to that.
    Similarly, a good example during the pandemic was around 
transportation. People wanted to get the vaccine, did not have 
caregivers around them, had a son or daughter-in-law living in 
a different State. We were able to arrange those rides for 
them.
    The other unique thing that we did during the pandemic and 
vaccination was, as people were getting vaccinated in doctors' 
offices and convention centers and pharmacies, we had folks who 
were homebound and could not leave their homes. We were able to 
get the vaccine to their home, not only for the members, but 
also the caregivers, because they were the ones taking care of 
their loved one, who happened to be with us.
    So those are some of the high-level benefits that we have 
used. We have done studies that show that, if you have 
transportation insecurity or food insecurity, you are going to 
have a worse outcome on your diabetes. And so we are 
consistently looking at ways and engaging our population with--
whether it be a program or a benefit, and ensuring them they 
have it, so as to fulfill their needs.
    Mr. Cardenas. Yes, thank you. And can you give us at least 
one example about what we can do, going forward, as Congress?
    What kind of effort can Congress afford you out there in 
the community?
    Dr. Batra. Absolutely. So as we--you know, first and 
foremost, I want to really thank the Congress for providing us 
the flexible--benefit flexibility. We were able to design all 
these newer benefits to meet the social needs of the population 
that started in 2019. So the benefits that I alluded to: in-
home caregiving, meals after discharge, care coordination, 
support, and occupational therapist. However, these are based 
on medical needs, so you have to have a qualifying diagnosis, 
like you have diabetes or you have heart disease or end-stage 
renal disease.
    If you truly believe there should be equality for all, if 
you truly believe that social needs are the first and foremost 
drivers of health, then perhaps we should be allowed to kind of 
design some of the benefits based on the social needs of the 
population. So that is one area that comes to my mind.
    And the second area is, during the pandemic, as we were 
scrambling we did about 100,000 social outreach calls to--
checking on members. We actually have a benefit that helps 
people sign up so they can--somebody can be their help, so they 
can have the telehealth visit to their doctors. We notice there 
are ZIP Codes with a high social vulnerability index, where 
people did not have access to Wi-Fi and iPads and technology. 
And for those, the telephonic assistance was really, really 
important in order to extend the reach of the primary care 
physician. That is the other area we really want Congress' 
help, in keeping telephone as one of the ways of engaging with 
the member, engaging with the patients, and helping them.
    Mr. Cardenas. Thank you, Dr. Batra. And it is very rare for 
us Members of Congress to get a thank you. So thank you for 
slipping that thank you in there.
    And I just wanted to say how focused many of us are on 
making sure that we modernize our public health data, 
infrastructure, and outreach, because those are some of the 
major lessons that we learned during this pandemic.
    My time has expired, Madam Chair. Thank you so much for 
having this hearing. I yield back.
    Ms. Eshoo. You are most welcome. It is a pleasure to 
recognize one of the doctors on our subcommittee. And we have, 
I think, five. I think five doctors.
    Dr. Dunn from Florida, you are recognized for your 5 
minutes of questions.
    Mr. Dunn. Thank you very much, Madam Chair, and also thank 
you, Ranking Member Guthrie, for hosting this hearing today to 
examine the ways that data can affect public health.
    You know, over the course of the COVID-19 pandemic, 
Congress spent hundreds of millions of dollars to support data 
collection and data infrastructure modernization. And whether 
those dollars were used for a centralized CDC data assimilation 
or grants to States and local governments for data collection, 
the money is already out the door. And we need to evaluate how 
these funds are being used, I think, before we consider another 
slate of new bills to advance more data collection as it 
relates to improving the care of the health of the American 
people.
    High-quality healthcare starts with the doctor-patient 
relationship. Dr. Syed said that in his testimony. And then it 
should consider the individual needs of patients. You can't 
just crunch data and pigeonhole people without taking a 
holistic approach to the patient.
    We also can't rely on bureaucrats in Washington to make 
decisions about healthcare for our individual patients. People 
simply cannot be reduced to a set of data points, no matter how 
voluminous they are.
    I also want to associate myself with the remarks of my 
colleague, Dr. Burgess, when thinking about requiring more and 
more data collection. The potential that that information will 
be shared across other entities requires that we have reliably 
strong safeguards in place to ensure patient data remains 
private and that HIPAA protections are, in fact, upheld. And 
with that I would like to ask Dr. Syed a question.
    I appreciated reading your testimony, hearing your views on 
creating more value in the healthcare system. You touched on 
coordination of care and a strong doctor-patient relationship 
and matching the resources to the patient's needs in order to 
drive improved outcomes. It seems to be you are an advocate for 
the flexibilities that the Medicare Advantage system allows, in 
terms of value. And you cited many examples in your testimony, 
and let me say I share those views with you.
    From your perspective, is increased data collection in the 
primary care setting the sine qua non to improved health 
outcomes?
    And so a lot of these proposals are talking about involving 
significant additional reporting requirements and gathering a 
great deal of data. And I know personally that doctors are 
already suffering from a fair amount of burnout and stress over 
administrative burdens. Dr. Bucshon made allusion to that in 
his questions. What is your perspective on that question, sir?
    Dr. Syed. Thank you very much. I--with regards to data and 
collecting more data to improve patient health, there are some 
things that I feel, as a doctor, I could speak to.
    When we are talking about improving health, I am thinking 
about, if we know medications are critical to improving health, 
we should not let patients walk out the door without their 
medications. Like, if we know that heart disease is the number-
one killer in the country, then we should have cardiologists 
working hand in hand with the primary care doctors. And if we 
know that a major part of improving health is overcoming the 
barriers to the care, then we should have social workers 
integrated into the care teams.
    I think, rather than collecting more data, we should kind 
of relook at how care delivery is happening right now in the 
country. And to what someone else said earlier today, you know, 
if we know that doctors are getting burnt out from doing all 
the nondoctor work, we should have the care teams take over all 
the administrative duties and just let the doctors be doctors.
    Mr. Dunn. So I--and let me say I like that answer very 
much. It certainly would have made my life a little easier the 
last 10 or 15 years.
    You shared a story about uncontrolled diabetes, I believe, 
in your father.
    Dr. Syed. Sure.
    Mr. Dunn. And I think that you would agree that data helps 
with that. But also, it is that personal time you spend with 
them, saying, ``Let's work with each other, and let's do the 
right things.'' In other words, it is really a relation step 
with the doctor-patient relationship. Would you agree with 
that?
    Dr. Syed. Absolutely. I think about--yes, absolutely. I 
think about a patient I had with morbid obesity. And because of 
the flexibility with the Medicare Advantage program, I was able 
to see him as often as I needed to see. And I was more of a 
health coach than I was a doctor for him. And I was able to--in 
6 months I was able to see him 7 times and get his weight down 
from 250 to 220 pounds. In my previous job, I couldn't even see 
him more than twice a year. So that is just the difference. It 
is a different, completely different, approach towards 
delivering on the care.
    Mr. Dunn. Certainly--our time is about over here--I was 
saying I certainly appreciate that. I agree with you.
    In Florida we experimented with sort of a hybrid Medicare 
Advantage/Medicare fee-for-schedule, so--the specialists and 
the primary care, working together.
    But I thank you for your comments, I thank the witnesses, 
and I thank our chair and ranking member, and I yield back.
    Ms. Eshoo. The gentleman yields back, It is a pleasure to 
recognize the gentleman from Maryland, Mr. Sarbanes.
    You have 5 minutes to question. Great to see you.
    Mr. Sarbanes. Yes. Thank you, Madam Chair. I want to thank 
the witnesses for being here for this important hearing.
    I deeply share the concerns of my constituents and those at 
our hearing today about the impacts that the coronavirus has 
had on communities of color. I believe Congress should use 
every available tool--and equitable recovery as well as address 
the root causes that have created health disparities for years.
    For too long, the Federal Government has failed to 
adequately recognize and address structural racism as the 
public health crisis that it is. Black and Brown communities 
have been denied access to quality, affordable healthcare, have 
faced barriers to securing safe, quality, affordable housing, 
and have suffered the consequences of environmental racism for 
generations.
    The COVID-19 pandemic, as we know, unveiled and exacerbated 
longstanding racial disparities in health outcomes. It is time 
we recognize and treat structural racism and police brutality 
through a public health lens when we can.
    Under the Biden administration, the CDC has begun this work 
by declaring racism a public health threat and committing to 
addressing racism in the context of health equity. I commend 
the CDC for this step, and we in Congress are committed to 
assisting in the effort. One way to do that is by passing the 
bills we are discussing today, including the Anti-Racism in 
Public Health Act and the Social Determinants Accelerator Act.
    The Anti-Racism in Public Health Act is a critical bill 
introduced by my colleagues, Representatives Ayanna Pressley 
and Barbara Lee. This bill would expand Federal research and 
investment into the public health impacts of structural racism, 
require the Federal Government to proactively develop 
antiracist health policy, and take a public health approach to 
combating police violence. Among other things, it would create 
a national center for antiracism at the CDC, which would award 
grants to study the health impacts of structural racism.
    Dr. Walker, I wanted to turn to you to elaborate on this a 
little bit. What is the significance of the CDC recognizing 
racism as a public health issue?
    Dr. Walker. There is clear evidence that racism creates a 
public health threat, and it creates not only immediate 
stressors but also long-term health effects that we need to 
combat.
    But many of those factors are ones that we have talked 
about: the social indications around housing, around 
transportation, around can you just get access to the care that 
you need?
    We know, for children and adolescents, some of those 
factors are around mental health access and needs, and 
resources in schools. And so having the ability to really 
provide Federal resources to make sure that States and local 
communities can invest in these factors and increase the 
ability to address it at a community need base, on those 
priorities and those areas of local context, are important for 
us to be able to incentivize health and well-being at the most 
local level.
    Mr. Sarbanes. Thank you very much. And I am sure you would 
agree that gathering up research and data in this space, and 
having that inform this perspective on the health impacts of 
structural racism, is also a key undertaking.
    What significance would it have to establish a national 
center for antiracism to serve as a resource hub to share 
information at the Federal, State, and local levels, in your 
view?
    Dr. Walker. I think that the benefit is that we could make 
sure that there is some data standardization but also expertise 
that often is not accessible in State agencies. So having a 
national center can lend technical support, can lend some data 
standardization, but also can support--and collaboration with 
academic partners in State and local data. And I think having 
those resources come together in a national center can be very 
beneficial and can't necessarily be done 50 times over in other 
areas. And I think that is a--national center, we have worked 
with them in the past and I think can be a great resource.
    Mr. Sarbanes. Thank you.
    Ms. Blauer, at Johns Hopkins--and let me just say how proud 
I am, being from Baltimore, about the great work that Johns 
Hopkins has done, particularly gathering critical data during 
the pandemic, and the university's Coronavirus Resource Center, 
as we all know, was a trusted source of information for so many 
people over the past year.
    Could you expand on the role data played in responding to 
the pandemic, and what additional data and resources might have 
been helpful, particularly to respond better to the challenges 
faced by communities of color during the pandemic?
    Ms. Blauer. Yes, thank you, Congressman. I can say that it 
wasn't until several months into the pandemic response in our 
work that States even started to release COVID data, 
demographic data that was rich enough for us to even validate, 
the kind of frontline anecdotal information we were getting 
about the disproportionality that that virus was having on 
residents.
    And it has taken us a long time to even get any kind of 
guidance around demographic sharing of data. We are still only 
at the CDC reporting around 60 percent of demographic data for 
the cases and the deaths of people that have been impacted 
disproportionately by the virus. We are still operating, 
certainly, in an environment of confusion when it comes to the 
disproportionality and the effects. And so having some guidance 
and some standardization around demographic data is so vital as 
we continue this last mile of work around COVID, but certainly 
as we think about how we look at the social determinants of 
health, and the role that data plays in deepening disparities 
and exacerbating bad outcomes for people. Thank you.
    Mr. Sarbanes. Thank you, I yield back.
    Ms. Eshoo. The gentleman's time has expired. The gentleman 
from Georgia, Mr. Carter, you are recognized for your 5 minutes 
of questions.
    Where are you?
    Mr. Carter. Thank you very much, Madam Chair, and thank----
    Ms. Eshoo. Are you in the car?
    Mr. Carter [continuing]. The witnesses----
    Ms. Eshoo. Are you in the car? Where are you?
    Mr. Carter. No.
    [Laughter.]
    Mr. Carter. I am in the hearing room.
    Ms. Eshoo. Oh, good, OK. I am glad you got out of your car.
    Mr. Carter. I am, too. Thank you, Madam Chair, and thank 
the witnesses for being here. Very important subject matter.
    Dr. Batra--I apologize--and Dr. Syed, Medicare Advantage 
plans have more than doubled enrollment over the past decade, 
and these plans clearly offer beneficiaries greater benefits 
and care versus traditional fee-for-service plans. And this is 
good. This is a good product that, obviously, is being 
utilized, and I am glad to hear that.
    My question, Dr. Batra, is this: How would beneficiaries 
benefit by Medicare Advantage plans offering new and existing 
breakthrough technologies and devices that are FDA-approved but 
do not fit into an existing benefit category for certain 
targeted populations, like those with chronic conditions?
    Dr. Batra. Yes, we--I think what we have done consistently 
is look at, as these new things become available, what has 
shown proven evidence, what has shown to prove--help with the 
needs of the membership that we serve. Wherever we have, you 
know, guidance from Medicare, either through their NCDs or 
LCDs, we follow those guidances. Where we don't have guidance 
available right away, we look at other data sources, other 
peer-reviewed studies, other evidence-based sources, and see if 
we can fit the need of the population and go from there on.
    The other thing that we have done and encouraged in our 
members is, as things become available, some of them are in the 
experimental trial phases, which is available through them--to 
them through Medicare trials.
    Mr. Carter. I don't mean to interrupt you, but I indicated 
if they were FDA-approved.
    Dr. Batra. Oh, they are FDA-approved, and we do have the 
flexibility in evaluating what is available, in terms of 
evidence, and then considering them for the right populations.
    Mr. Carter. OK, and you have a review process for that, 
whereas you review it among your yourselves----
    Dr. Batra. Yes.
    Mr. Carter [continuing]. And decide whether it is going to 
be covered or not?
    Dr. Batra. Yes, we do have medical policy departments that 
work together alongside our provider partners, working very 
closely with our provider partners, alongside experts--some of 
them are academic experts--to review them on a case-by-case 
basis, to look at the needs in a population, to look at what 
else is available, to look at the comparative effectiveness. So 
multiple factors play a role in that.
    Mr. Carter. OK. Dr. Syed, what about you? What about your 
company?
    Dr. Syed. Our--we understand that more than 70 percent of 
modifiable health outcomes are actually based on a preventive 
lifestyle, lifestyle interventions. So when you have a system 
that is focused on prevention and the doctors are allowed to 
focus on prevention, then the patients are more safe at home 
rather than going to the hospitals. It eliminates all the 
medical costs, actually, before they even occur. You know, we 
focus on improving health and reducing suffering through 
preventive and early interventive measures.
    If there is an FDA-approved treatment or a product that can 
help benefit the patients, then, as long as it is FDA-approved, 
then we would evaluate that on a case-by-case basis.
    Mr. Carter. Do the individual patients have some type of 
appeal process, some kind of prior approval process, or 
anything through your company?
    Dr. Syed. I--that I am not--in the full risk model, I am 
not aware of having to go through that type of process.
    Mr. Carter. OK, all right. Let me move on.
    Dr. Batra, again, I serve a very rural community, and many 
of my constituents have trouble getting to physicians for care. 
Even during the past 6 months, many of these same constituents 
could not access vaccines for extended periods of time. It 
appears that SCAN Health Plans have been recognized as a leader 
in getting COVID vaccines to homebound and rural patients. Can 
you share with us what you all are doing to--that maybe other 
plans could duplicate to improve access to care for 
beneficiaries in rural communities?
    Dr. Batra. Absolutely. We absolutely follow the principle 
of leave no older adult behind. So, right from the very 
beginning, as the vaccine was being developed, we put all hands 
on deck on figuring out how do we get the right people to the 
right places. Those who could drive, how do we get them there, 
give them information, and those who could not get there, how 
do we get them rides to get there?
    But we also serve a large swath of people who are homebound 
members, who have caregivers taking care of them. So we worked 
very closely with an organization that then deploys paramedics 
in people's homes that could carry the vaccine in a safe way, 
had oversight provided by nurses and physicians. We were able 
to schedule those visits for them. And within the comfort of 
their own home, under watch of a paramedic, as well as the 
oversight of a nurse, we were able to deliver those vaccines in 
people's arms. To date we have done several hundred of those, 
and we will continue doing that with the goal of leaving no 
older adults behind.
    Mr. Carter. Well, I just want to compliment you and thank 
you, for your service to the rural communities, in particular, 
is extremely important. So thank you.
    And I will yield back.
    Ms. Eshoo. The gentleman yields back, and now another one 
of the doctors on our subcommittee, Dr. Ruiz from California.
    You are recognized for your 5 minutes of questions.
    Mr. Ruiz. Thank you, Chair. This is so important. Finally, 
it is a premed dream come true. You see, back in the 1990s, 
when I was premed and in medical school, those of us who 
understood social determinants of health would shout it out in 
lectures. We would talk about it in the halls of the different 
academic hospitals. And everybody was so singularly focused on 
the specifics of medicine, that they didn't really understand.
    And now we are actually having a hearing on how to improve 
data collection for social determinants of health and our 
public health system. This is groundbreaking. This is 
incredible. This is the spear of much more to come, the tip of 
an iceberg.
    And I am so proud of Congressional Hispanic Caucus member 
Nanette Barragan and all the other members of our committee who 
have pushed forward great legislation to finally get our social 
determinants of health in the limelight, so that we can really 
take a comprehensive look at health.
    It is not just the absence of disease. It is the ability to 
enjoy one's life and have wellness and fulfill our human 
potential in our communities. And from breathing in the toxic 
air around the Salton Sea in my district, to working in the 
fields, the grape fields, the bell pepper fields under the 
blazing sun, to food insecurity, I have seen firsthand in my 
district how social determinants negatively affect my 
constituents and my patients'--I am an emergency physician, by 
the way--my patients' health.
    So many of my constituents do not have access to healthy 
foods, whether that is because they live in a food desert or 
because healthy food is more expensive. Ironically, the same 
farm workers who pick the healthy foods can't afford those 
healthy foods at this--sometimes, or they do not have adequate 
health insurance.
    So no matter what the reason is, all these factors 
contribute to higher rates of underlying chronic diseases like 
obesity. In fact, nearly half of Black and Hispanic Americans 
are living with obesity, and this puts them at greater risk of 
200 serious diseases, including serious conditions like 
diabetes and heart disease and serious complications of COVID-
19.
    This is why I joined several of my colleagues in 
introducing H.R. 1577, the Treat and Reduce Obesity Act, which 
would increase access to effective treatments for obesity. 
Bills like the Treat and Reduce Obesity Act, as well as several 
that are under consideration today, will help us address some 
of these social determinants of health straight on.
    And while it is critical to address the social determinants 
of health in order to improve the health of all Americans, we 
cannot do that without really understanding the problem. And to 
really understand the problem, we need adequate, accurate, and 
timely data that describes the social factors that impact 
health outcomes like economic status, access to transportation, 
access to healthy foods, educational attainment, housing, and 
environmental influences on health.
    This data has been challenging to procure in public health, 
in part due to a number of barriers that range from inadequate 
design of systems like electronic health records to the use of 
phone survey systems and a lack of trust for those being asked 
about their social risk factors.
    Dr. DeSalvo, can you speak more on the importance of 
collecting health quality data on the social determinants of 
health, and then how to translate that into actual policy and 
public health programs?
    Dr. DeSalvo. Congressman, let me just first say I woke up 
with that same enthusiastic pep in my step today. This is, 
like, 20 or 30 years of work, and all the data, equity, and 
public health together and the social determinants are just the 
things that I care so passionately about. So I appreciate your 
enthusiasm and really look forward to working with you and 
others as we bring this to fruition.
    Maybe I will just hearken back to my experiences in New 
Orleans, since you mentioned obesity, and say that when I was 
the health commissioner, one of the first--when I went two 
blocks down the street from my medical school, where I was 
faculty, and took the helm of the health department, I had in 
my head all the information from the quantitative survey data I 
had seen saying that cardiovascular disease and cancer were 
killing the people in my community. And I needed to focus on 
that.
    Within the first 5 minutes of the first coffee I had in a 
church hall, they said, ``Our priorities are violence, mental 
health, and economic opportunity.'' And it was a real mind 
shift for me, of really respecting and appreciating that the 
data I might see that is quantitative and collected in some 
ways doesn't always reflect the now and what is on the mind of 
my community.
    And so mixing qualitative and quantitative is important. We 
can scale that by leveraging novel data sources. I mentioned 
earlier search symptoms trends that public health could use. It 
is anonymous and can give them a snapshot of their community.
    But I took those lessons from them, and I looked at a 
through line and realized that fitness, obesity, lack of 
nutritional fitness were contributing to cancer and 
cardiovascular disease. And as I talked to them more, I 
realized they needed sidewalks, playgrounds, access to healthy 
foods. We had to work with our economic department to get 
grocery stores to go in communities. We had to work on school 
lunches. Kids designed it, told us they wanted--you know, how 
they wanted the salad, what would drive them to go away from 
french fries and pizza, and have some other healthy food. We 
did it with kids, not for them.
    So I think what--once you have the data in front of you, 
quantitative and qualitative, local leaders can bring people 
together, and that community can make decisions about how to 
make interventions and measure success, so we can know what 
works and continue on that generational trajectory of improving 
health.
    Mr. Ruiz. I love it. Thank you all for the work you do.
    Ms. Eshoo. The gentleman's time has expired. The gentleman 
from Florida, Mr. Bilirakis.
    Mr. Bilirakis. Thank you, Madam Chair.
    Ms. Eshoo. You have--minutes for your questions.
    Mr. Bilirakis. I appreciate it. Thank you. Thanks for 
holding this very important hearing. Madam Chair, data drives 
decision making, as you know. And the integrity of these 
decisions lies in the integrity of the data.
    As you know, I am from the great State of Florida, and 
Florida's COVID-19 story is one of success driven by reliable 
data and following the science. I have included a press release 
exposing myth versus fact regarding Florida's COVID-19 data. 
And I ask unanimous consent that this be entered into the 
record, Madam Chair.
    [Pause.]
    Mr. Bilirakis. Madam Chair?
    Ms. Eshoo. Did you hear? So ordered.
    [The information appears at the conclusion of the hearing.]
    Mr. Bilirakis. Yes, I--OK, thank you. Yes, I didn't hear 
that. Thank you.
    Dr. Walker, Representative Blunt Rochester and I introduced 
the bipartisan Collecting and Analyzing Resources Integral and 
Necessary for Guidance for Social Determinants Act, and it is 
H.R. 3891--excuse me, 3894. And what it does is it provides 
regularly updated guidance to States to address social 
determinants of health under Medicaid and CHIP, building upon 
the success that some State Medicaid programs have already had 
since testing innovative delivery and payment models.
    Additionally, several members of this committee are 
championing the Social Determinants Accelerator Act, which is 
H.R. 2503, which would help States and communities devise 
strategy to better leverage existing programs and authorities 
to improve the health and well-being of those participating in 
Medicaid.
    So my question is a couple of questions. How might HHS do 
more to coordinate social determinant efforts, even without 
additional congressional authority?
    And then also, could you explain how HHS could use its 
leadership in Medicaid to more broadly catalyze efforts to 
better coordinate and measure the impact of resources and 
initiatives that address social determinants of health?
    And this is for Dr. Walker.
    Dr. Walker. Thanks, Congressman, for the opportunity to 
address this question.
    It is absolutely critical to think about how to refine 
ongoing guidance to States around how to address social 
determinants of health. We know these impacts continue to 
evolve, and so, even when I was State secretary of health and 
social services, it was extremely helpful to have this updated 
guidance provided. It informs waivers, it informs how you can 
think about State plan amendments. And as you mentioned, it 
doesn't require, necessarily, additional authority but gives 
clarity around where existing resources can be deployed and 
used most efficiently.
    And there are several models out there. So another strategy 
could be that models like that at the State level are 
incentivized through CMMI or other waiver authority like North 
Carolina's.
    I expect we will continue to learn from these models, so 
having evaluations and the data available can be incredibly 
useful but also providing resources for technical assistance, 
updated guidance, and examples are tremendously beneficial. 
Thank you.
    Mr. Bilirakis. Thank you. And the next question is for Dr. 
Batra.
    Recently I introduced H.R. 4074, the Addressing Social 
Determinants in Medicare Advantage Act, which increases 
flexibility for Medicare Advantage to offer supplemental 
benefits that would help address social determinants of health. 
Can you discuss how supplemental benefits have improved the 
lives of your members and how adding benefits that address 
social determinants of health in Medicare Advantage and 
broadening beyond just those with specific chronic conditions 
would mitigate social inequities and allow plans to assist even 
more members in need?
    Dr. Batra. Absolutely. I have shared with the committee 
before, we really appreciated getting that flexibility. Post 
that flexibility, we have designed multiple, newer benefits. I 
mentioned our benefit called Return to Home around medications, 
care coordination, and in-home caregiving. We also introduced 
benefits like respite care for our populations who have 
caregivers who could use that kind of help, so we use benefits 
for that.
    Beyond that, we extended our meal benefits to provide meals 
for our folks suffering from chronic conditions, who perhaps 
need that meal for their diabetes or need a meal for their end-
stage renal disease that is appropriate for the condition, so 
they can have a better food lifestyle in order to improve on 
the chronic conditions.
    So those are a few high-level benefits that we introduced. 
We have seen, based on our--either both the utilization 
adoption data as well as our outcomes data when we look at our 
utilization from ER visits, or admissions or improvement in 
diabetes control and improvement because of those kind of 
benefits.
    We continue looking at more benefits. And as I had shared 
with the committee, I would love to have benefits based on your 
social needs or just based on your medical conditions. Right 
now we do have the flexibility, but they are still tied to 
chronic conditions like diabetes or heart disease or 
cardiovascular disease or chronic kidney disease. But we know, 
as I shared, we have about 20 percent of our membership that 
has, at one time or the other, shared with us they have food 
insecurity. We would be able to do more if we were able to 
address the needs of a larger population, not limiting 
ourselves just to chronic conditions. Thank you.
    Mr. Bilirakis. Thank you.
    And I just want--Madam Chair, this particular bill, H.R. 
4074, I filed it, due to timing, alone. But I welcome 
bipartisan support, both in this committee, Ways and Means, and 
any Members that want to--I think this is a very important 
issue for the constituents.
    Thank you, and I yield back. Thank you for the extra time, 
Madam Chair.
    Ms. Eshoo. Yes. The gentleman yields back. It is a pleasure 
to recognize the gentlewoman from Michigan, Mrs. Dingell, for 5 
minutes of questions.
    Mrs. Dingell. Thank you----
    Ms. Eshoo. Right there from the very beginning, and taking 
everything in. And I think we hear more bounce in your voice, 
so you are feeling better.
    Mrs. Dingell. We are getting there, slow but sure.
    Ms. Eshoo. Good, good.
    Mrs. Dingell. Thank you, Madam Chair--wonderful--and 
Ranking Member Guthrie for convening this hearing to discuss 
legislation to address deficiencies in public health data and 
technologies, which I really care about.
    As our witnesses have mentioned, the HITECH Act and funding 
have led to improvement in data collection that have helped 
drive better outcomes for patients in the clinical settings. 
However, while we have seen additional resources directed at 
gathering and disseminating actionable public health data 
during the COVID-19 pandemic, longer-term reforms are needed to 
address these gaps in our public health data infrastructure.
    Additionally, doing so will allow us to better direct 
healthcare resources towards areas of greatest need to better 
address deep-seated inequities in disadvantaged communities or 
populations. And I love seeing Dr. Ruiz excited, so I want to 
get him the data he needs to be able to do that.
    But my questions are for you, Dr. Batra, because it was 
good to see you highlight the Independence at Home program in 
your testimony. IAH ensures Medicare patients can maintain 
their independence while meeting their unique medical needs and 
lowering costs. And I was glad to part with my colleagues on 
this committee as part of a bipartisan effort to successfully 
reauthorize and expand the IAH program at the end of last year.
    Dr. Batra, you also mentioned that voluntary health risk 
assessments used to identify members' health needs have a 35 
percent response rate--not very good--with a completion rate of 
80 percent for special need plan members. What barriers do you 
see in raising response rates for these assessments?
    Dr. Batra. Absolutely. Right now, the way we do these 
assessments are either over the phone or through mailing. But 
you are absolutely correct. We could do more.
    We have a significant membership that is aging in and 
joining MA plans, including ours. For them we have to be ready 
to provide an online assessment, if that is the way they want 
to engage with care. So that is one area that we are exploring.
    The other area that we are also exploring is for folks who 
perhaps are homebound, have caregivers who are really busy 
doing other things and not have the time to fill out the 
assessments, or they are not available themselves--of 
assessments. So could we go into their homes and help do those 
kind of assessments to get a better idea on them? That is a 
second way of doing it.
    The other things that we are also exploring is building out 
these assessments in different languages. We are based out of 
California. We serve a diverse population that speaks many 
different languages. We right now have assessments that are 
available in three to four languages. We need to address the 
needs of our population. We really have to expand those 
languages, as well, so we can really get feedback from all of 
our members, not just some of our members.
    So those are a few areas that we are thinking about.
    And then finally, you know, our providers also do a lot of 
assessments, and we are looking at interoperability to say, 
hey, where we do not have those assessments, perhaps our 
providers have it. How do we get that data and build it in our 
system, so that we have a more holistic understanding of our 
population?
    Mrs. Dingell. So let me follow up on that--and I am going 
to run out of time, so I am not going to be able to ask all my 
questions--but how do nonresponses and other gaps in data 
affect your organization's ability to provide targeted 
intervention to seniors based on social determinants of health?
    Dr. Batra. It does make a big difference because we--
generally, when we get this data, that is where we act on. We 
have an algorithm to say who is going to reach out, who should 
be offered certain programs, who should be enrolled in certain 
services. So we are always looking, how can we make our data 
more comprehensive and robust?
    And our approach has been to work with our providers to see 
how we can further make that data more comprehensive.
    Our approach also has been, how do we engage with 
caregivers? Perhaps they are also the people who can help us in 
getting those assessments completed.
    How do you work with community-based organizations? Looks 
like Meals on Wheels that perhaps are going in people's homes, 
and get data from that perspective.
    So we are trying to look from everybody who is available at 
the community level, at the individual level, at the provider 
level, at the delivery system level to make that data complete.
    Mrs. Dingell. OK, so I am going to rush a question. So 
missing, incomplete, or nonstandard public health data is more 
common than anybody would like, particularly when it comes to 
long-term services and supports as well as other services 
utilized by our Nation's seniors, which I care deeply about. 
And I was a caregiver. Yes, I could have filled it out better 
than anybody.
    But how would uniform public health standards, like those 
in the Health STATISTICS Act before us today as well as 
improved quality measures for LTSS, improve your organization's 
ability to meet the need of older adults your organization 
serves?
    And you have 1 second.
    Dr. Batra. Absolutely. We do have a fully integrated dual 
eligible specialties plan, so we do offer those long-term 
services and supports. We absolutely believe in the importance 
of it. And so we are working with in-home community partners, 
caregivers, formal and informal, in completing the data.
    Mrs. Dingell. OK, thank you.
    I yield back, Madam Chair.
    Ms. Eshoo. The gentlewoman yields back. It is a pleasure to 
recognize the gentleman from Utah, Mr. Curtis, for your 5 
minutes of questions.
    Mr. Curtis. Thank you, Madam Chair. I am pleased to be here 
today.
    Dr. Batra, my bipartisan legislation coled by my friend Mr. 
Cardenas that we are discussing today aims to give private 
individual market health insurance plans more flexibility and 
incentive to spend money focused on improving patient outcomes. 
It does this, specifically, allowing plans to count social 
determinants of health expenditures toward the Affordable Care 
Act's medical loss ratio requirement. Services could include 
partnering with ride sharing companies to help beneficiaries to 
get to and from appointments, or even paying for groceries.
    While SCAN is a Medicare Advantage plan not in the 
individual market, could you explain how insurance plans are 
engaged in providing social determinants of health services to 
beneficiaries?
    Dr. Batra. For us, as a MA plan, we design our benefits 
based on the supplemental benefits that are made available. One 
more time, they are made available based on the chronic 
conditions that they have. If you look at our ongoing data and 
look at opportunities to close gaps in care, whether they be 
social gaps in care or, in some context, it may be even medical 
gaps in care, like affordable medications or access to 
telehealth vendors, so our approach of planning and designing 
benefits is based on that approach, and also offered through 
the Congress giving us the flexibility to design these kind of 
benefits with social needs as one of the drivers.
    Mr. Curtis. So that plays right into my next question, 
which is what can Congress be doing to help offer incentives to 
help you do your job better?
    Dr. Batra. In my mind, offering these benefits in a more 
holistic manner will really help us a lot.
    So right now, the benefits, one more time, are based on 
your medical condition, which we know is the driver for 10 or 
15 percent of your overall outcome. If we were able to design 
those benefits based on your social conditions--perhaps you are 
housing insecure and do not have other chronic conditions that 
may have qualified you for a benefit--that would be one idea 
for us to do it.
    And also thinking of populations that perhaps are not 
completely fitting into the MA mold, so people experiencing 
homelessness--could we offer them some differentiated benefits, 
based on their social needs versus just their medical needs?--
is another one that comes to my mind.
    Mr. Curtis. That is good. Thank you. Could you comment on 
this--along those same lines, would it be helpful to remove 
some of the barriers such as reforming Stark Law, and could 
that enhance care coordination between providers, increasing 
savings for the patients?
    Dr. Batra. It is always great, and being a primary care 
physician, the more we can collaborate and coordinate with the 
primary care physician--not only just the primary care 
physician, but their teams, and their extensions of their 
teams, whether it be in the hospital setting, or be it in the 
ER setting--we are always looking at opportunities to do more 
of it, whether it be through the data exchange or it be through 
our teams or working closely together.
    Mr. Curtis. Thank you.
    Dr. DeSalvo, could you talk for a minute about how Google 
is partnering with healthcare systems or insurance plans to 
gain a stronger understanding for healthcare trends in certain 
communities or within patient populations?
    Dr. DeSalvo. Thank you for the question, Congressman. I 
think one of the opportunities that we all have has come up in 
the hearing, and that is how can the data that is already 
available be more intuitive, more accessible, easier for the 
doc or nurse to find right at the bedside or in the clinic.
    Also, for the patient, how do we minimize or reduce the 
need for them to repeat over and over again what their medical 
conditions are or, in the case of social determinants, to have 
to prove they are hungry or unhoused over and over again? What 
are the ways that we can be more efficient and effective with 
the data that we are already collecting?
    And so, in that context, Ascencion Health System asked if 
Google could be helpful to apply that notion of making the 
electronic health record data easier to find and make it more 
intuitive for doctors when we are trying to make sure we can 
not only get through the day with our patients but be able to 
spend time looking them in the eye and not looking at the 
computer.
    Mr. Curtis. Yes.
    Dr. DeSalvo. So that is an example----
    Mr. Curtis. If----
    Dr. DeSalvo [continuing]. Of how we are working on data.
    Mr. Curtis. I am going to jump in on you, simply because we 
are----
    Dr. DeSalvo. OK.
    Mr. Curtis [continuing]. So short on time. Talk to me for 
just a little bit about privacy of this data, and how do we put 
patients totally in charge of their own data and still reach 
our interoperability goals?
    Is blockchain technology--what technology is out there that 
we can be thinking about to give patients total control over 
their data?
    Dr. DeSalvo. Oh, thank you. Thank you for raising that, 
because, first and foremost, people do need to understand how 
their data is being used. That is the transparency piece. They 
need to have choice about who is going to get it and then 
control across the journey, something that I spent a lot of my 
career working on.
    And in fact, as we have talked about earlier today, 21st 
Century Cures pushed this idea of APIs, doorways to the data 
that consumers control. So it is a great example of how 
consumers have the control of saying, ``I want this data, and I 
want to share it in--with these trusted healthcare partners,'' 
for example. All of that would fall under HIPAA and with 
consent, so that the notions are already there and the systems 
are building.
    And the last administration, in the interoperability rule, 
further pushed this idea technologically, raising an important 
additional concept, which is, are there ways that data isn't 
all stored in one place and that it can be visited or borrowed 
in the moment, when the person is either critically ill, having 
a heart attack, or when you need to use it for more long-term 
diabetes care?
    For pretty early in the journey of knowing how tools like 
blockchain will work, though, there are many in the healthcare 
system, in the healthcare environment, in the technology 
environment trying to understand it.
    I just want to emphasize the point again that consumers 
do----
    Ms. Eshoo. The gentleman's time is----
    Mr. Curtis. Yes, I am so sorry.
    Ms. Eshoo. It has expired, I am sorry.
    Mr. Curtis. Yes, Madam Chair, I yield my time. Thank you.
    Ms. Eshoo. OK, thank you.
    Mr. Curtis. And I hope we can explore that in more detail 
later.
    Dr. DeSalvo. I would be delighted to.
    Ms. Eshoo. Good. It is a pleasure to recognize the 
gentlewoman from New Hampshire, Ms. Kuster.
    Ms. Kuster. Thank you very much, Madam Chair, and thank you 
for bringing us together today to discuss the opportunities and 
legislation to bolster equity within public health. Today's 
hearing is timely, as we continue to safely reopen our economy 
from the grips of the COVID-19 pandemic and examine many of the 
underlying health inequities that existed before COVID.
    I have often said that this pandemic pulled back the 
curtain on so many health inequities and injustices, and it is 
critical for this committee to identify and advance legislation 
that will support the healthcare delivery and public health 
approaches for these impacted communities.
    One of my main focuses in Congress has been addressing 
health access issues in rural communities, which are oftentimes 
underserved and underresourced, to address their unique health 
challenges. We need to take a comprehensive approach to 
tackling this problem, which includes everything from expanding 
primary care options to increasing access to fresh foods and 
produce.
    The existence of food deserts represents a real challenge 
for our rural communities that is directly linked to worse 
health outcomes for rural Americans. Without access to fresh 
food, Granite Staters who live in food deserts may be at higher 
risk of diet-related health conditions such as diabetes, 
cardiovascular disease, and obesity.
    So that is why I am so pleased that today's hearing 
includes legislation sponsored by my colleague and good friend, 
Congresswoman Cheri Bustos, the Social Determinants Accelerator 
Act, which I am also proud to support. Economic and social 
conditions such as stable housing, access to transportation, 
and healthy food have a significant impact on public health and 
wellness, and this legislation will help States and localities 
devise strategies to leverage existing programs and boost 
health outcomes.
    So my question is for Ms. Odom Walker.
    Ms. Walker, your testimony touches on this bipartisan 
legislation and the positive impact it will have on health 
infrastructure investments. Can you expand on this and discuss 
how this legislation will help rural communities address health 
disparities and negative social determinants of health?
    Dr. Walker. Thank you, Congresswoman, for the commitment 
and need to elevate issues around inequities. And there is an 
interconnection between how we look at health and all of the 
social factors that influence our health outcomes.
    Being able to accelerate what works and do more of it, 
along the lines of creating partnerships between Federal, 
State, and local agencies is important. And we know that, in 
the light of the pandemic, that those interconnections were 
even more important. The inequities were highlighted.
    And so having the ability to provide technical assistance 
and resources to make sure that we are doing more of what works 
and focusing on the communities of greatest need, it is 
critically important. We know that those technical resources 
aren't always available, and having the data, having the know-
how to really move beyond what is kind of being done would 
promote health more broadly. Thank you.
    Ms. Kuster. Great. Well, thank you. Now, your expertise is 
children's health. And I appreciated you highlighting the 
intersectionality of children and maternal health. Can you 
discuss some of the specific challenges that parenting women 
face in rural communities?
    And how can this committee advance meaningful legislation 
to tackle the underlying negative social determinants for new 
mothers and their children?
    Dr. Walker. Absolutely. I think, again, it shows in the 
midst of the lifelong journey of health that health starts 
preconception. It starts during a healthy pregnancy. And the 
health of mothers is linked to the health of their children. 
And rural communities often don't have those same wraparound 
services but could be supplemented by home visiting programs 
and other factors, other supports.
    We know that factors like trauma and stress of the mother, 
even before conception, can impact the life course of the child 
well into adulthood. We need to make sure that there are 
resources for addressing maternal depression, and some of that 
could be supported through telehealth supports even if local 
resources are not available.
    But I think some of these other factors around nutrition 
and how we really think about creating that support impact both 
cognitive well-being and others. So trying to figure out how to 
deploy some of it through telehealth resources as well as local 
community resources can be a benefit, particularly in rural 
communities.
    Ms. Kuster. Well, and thank you for your reference to 
telehealth, because often transportation is a real barrier to 
access to healthcare.
    And with that, on the stroke of zero, I will yield back to 
the chair. And thank you so much.
    Ms. Eshoo. Excellent, thank you.
    It is a pleasure to recognize the gentleman from Texas, Mr. 
Crenshaw, for your 5 minutes of questions.
    Mr. Crenshaw. Thank you, Chairwoman. Thank you for holding 
this hearing today. It is an important one. And I want to talk 
about the variable that we are trying to understand, the social 
determinants of health. It goes--and going all the way upstream 
to understand what might be impeding access to care, what is 
preventing people from living a healthy lifestyle.
    So I am glad to hear that our private plans are working on 
this already. And as I know, many of them are solving problems 
of nutrition, which is a really critical piece of preventing 
health issues through food--you know, and one example is 
through food subscriptions, like Hello Fresh. Many offer rides 
through Uber or Lyft so they can get access to their doctor.
    So first, I think we have to make sure that the government 
isn't putting barriers in place that would impede private plans 
from addressing social determinants. And I am glad that my 
colleagues Mr. Curtis and Mr. Cardenas have a bill to do just 
that.
    Second, as we think through how to properly integrate these 
social determinants into our public health plans, I want to 
make sure we are thinking through social determinants as a 
piece of the puzzle and not the sole solution to healthcare 
problems.
    Finally, it is important to acknowledge, as we use social 
determinants to improve health outcomes, some of our most 
fundamental healthcare programs are still in desperate need of 
real programmatic updates. And simply integrating social 
determinants won't get at some of the most critical issues with 
Medicaid and Medicare, which is the fee-for-service system. So 
even the most straightforward solutions are really complicated 
by rules regarding payments and what regulations on what 
services to cover.
    Dr. Batra, my first question is for you. What lessons can 
the Federal Government take from the private plans on how to 
properly balance social determinants as they are integrated 
into our more complicated public healthcare system?
    Dr. Batra. I think the few things to learn from MA plans--
and I can speak for my plan--is having a very person-centered 
view and starting from what matters to the patient. And what 
matters to the member or patient or beneficiary is access, 
affordability, experience, and living the life to the fullest. 
So you have to balance all of them out.
    Medications is a big deal for them, so having affordable 
medications available to them. Access is huge and access 
getting to the doctor, so that is where social benefits become 
important to it.
    But also, when you cannot get to the doctor, how do you get 
to access, whether it be through telehealth, or it be in-home 
health, if required, is another piece of it.
    Mr. Crenshaw. But can we get to that point without actually 
innovating the process of what we choose to cover?
    I mean, you know, without reforming the fee-for-service 
system?
    You know, will traditional Medicare have to create and 
approved new benefit categories for, you know, those Ubers or 
that nutritional support? Is that really the most effective 
way?
    Dr. Batra. That is true, you will have to overhaul it. Like 
hearing aids, for example, is not a Medicare-covered benefit. 
So being a primary care physician, dental is so integral to 
your medical health as well as your overall health--is not 
currently covered by Medicare. There are other areas. Like, 
vision is not currently covered by Medicare.
    So there have to be certain areas of priority. And given 
today, where we are--technology can play a lot of roles in some 
of these areas. As we think about rural areas, for example, 
telehealth access could be one of them. Similarly, addressing 
social needs could be another one of them. And yes, you know, 
we can deliver food much better now, perhaps, than we could 
have done a few years back. So those all become core to it.
    And you are right, there has to be a balance between social 
and medical on both sides, I would say. Not only social and 
medical----
    Mr. Crenshaw. Yes.
    Dr. Batra [continuing]. But functional and behavioral, as 
well.
    Mr. Crenshaw. Thank you. My next question is for Dr. Syed.
    You know, based on your primary care experience, the 
practice you represent is dedicated to improving primary care 
for seniors. And I would like to know, would integrating a 
program modeled on direct primary care, which currently does 
not exist within our Federal payers like Medicare and Medicaid 
but would allow for beneficiaries a personal primary care 
coordinator--would you find that beneficial to improving health 
outcomes?
    Dr. Syed. You know, I find full-risk, full-capitated 
doctors and direct primary care doctors having much in common. 
I oftentimes compare our--both styles of practicing medicine. 
We are both two arrows that have been shot out of the same fee-
for-service bow.
    Definitely, there is a population of patients that 
benefit--that would benefit from direct primary care. I believe 
now there are over 20,000 direct primary care doctors out of 
200,000 primary care doctors in the country. So for a set 
population, I see there being benefit there. But in the world 
where I live in, my patients are struggling with the basics. We 
have centers, for example, in St. Louis where more than 90 
percent of the patients rely on us to provide them 
transportation services.
    Mr. Crenshaw. In my remaining time, could you also comment 
on the question I asked about moving from a fee-for-service to 
a value-based system and how that is necessary to really 
innovate and to be able to cover these social determinants?
    Dr. Syed. Absolutely. I would like for you all to think 
about value-based care, or especially the fully capitated 
value-based care model, as full responsibility, where the 
doctors, the primary care doctors and the primary care delivery 
team, assume all the responsibility. If the quality of the care 
is expensive, it is on the doctor. If----
    Ms. Eshoo. Yes, the gentleman's time has expired.
    Dr. Syed. Oh----
    Ms. Eshoo. I am sorry to interrupt.
    Dr. Syed. Sure.
    Ms. Eshoo. OK?
    Mr. Crenshaw. OK.
    Ms. Eshoo. Thank you.
    Mr. Crenshaw. I yield back my negative time.
    Ms. Eshoo. Thank----
    Mr. Crenshaw. Thank you, Chairwoman.
    Ms. Eshoo. I now would like to recognize the gentlewoman 
from Illinois, Ms. Kelly.
    And for those that are with us today as witnesses, she 
really is the mother of the issue of maternal health on our 
subcommittee.
    So, Congresswoman Kelly, take it away.
    [Pause.]
    Ms. Eshoo. Are you there?
    Voice. It seems like she is having technical----
    Ms. Eshoo. She may be having technical difficulties.
    Then let's give her a few minutes.
    Are you there, Robin?
    [Audio malfunction.]
    Ms. Eshoo. No, I think there is something wrong with your 
audio. Maybe they can get it straightened out, and we will come 
back to you.
    I will recognize the gentlewoman from California, Ms. 
Barragan, for 5 minutes of questions.
    Ms. Barragan. Thank you, Chair Eshoo, for holding this 
important hearing on advancing equity in public health, and for 
including my bill, the Improving Social Determinants of Health, 
as part of the conversation.
    I also want to thank my committee colleagues who have 
cosponsored----
    Ms. Kelly. Can you hear me?
    Ms. Barragan. Maybe we can ask her to mute.
    Ms. Kelly. Can you hear me?
    Ms. Eshoo. If Robin is on--and I don't see you--please 
mute, and we are going to circle back with you. But there is 
some background noise, so make sure you are muted, and we will 
be back to you in a few minutes for your 5 minutes of 
questions.
    You could proceed.
    Ms. Barragan. Thank you, Chair Eshoo.
    I also want to thank my committee colleagues----
    Ms. Kelly. I don't know what is going on.
    Ms. Barragan. I want to thank my committee colleagues, 
Representatives Butterfield, Cardenas, Clarke----
    Ms. Kelly. Can you hear me?
    Ms. Eshoo [continuing]. Recognizing you now, because we had 
some audio problems, but--so please mute, so that we don't have 
your background noise. Congresswoman Barragan is--has her 5 
minutes now, and we will circle back to you. OK?
    Mr. Ruiz. I will text----
    Ms. Eshoo. I hope you can hear me.
    Mr. Ruiz. I will text Representative Kelly, and if our--if 
committee staff can text her and her staff, as well, I think 
that----
    Ms. Eshoo. Well, my staffer is contacting her staffer. It 
is like, you know, my office calls yours, but it is--so far, it 
is not working. So I am trying to intervene by just--by saying 
so.
    OK. Ms. Barragan, you can----
    Mr. Ruiz. Can we give Representative Barragan a full 5 
minutes, due to those----
    Ms. Eshoo. I am not taking time out of her time for the 
interruption.
    You can proceed.
    Ms. Barragan. OK, thank you, Chair Eshoo.
    I also want to take a moment to thank committee colleagues, 
Representatives Butterfield, Cardenas, Clarke, Blunt Rochester, 
Rush, Kelly, Welch, and Castor for cosponsoring this critical 
legislation.
    The COVID-19 pandemic has had a devastating impact on 
communities of color. My district is nearly 90 percent African-
American and Latino, and I have seen what the crisis has done 
to low-income and underserved communities that don't have 
access to the services they need. Lack of access to 
transportation, unsafe or unstable housing, and food insecurity 
put individuals at a higher risk for worse health outcomes. 
Addressing these social determinants of health is crucial to 
reducing health disparities, not only during the current crisis 
but as we work to strengthen our public health infrastructure 
into the future.
    That is why I introduced the Improving Social Determinants 
of Health Act, which would provide funds to the CDC to 
establish a program focused specifically on social 
determinants. It would also establish a grant program for local 
public health departments to tackle these underlying issues 
that contribute to inequity.
    Dr. Walker, how have social determinants of health 
contributed to minority health disparities, including worsening 
health outcomes for those in underserved communities?
    And why have these factors made it harder to care for 
communities of color during the recent pandemic?
    Dr. Walker. I think one of the first things that I 
recognized when the pandemic arrived in Delaware was that the 
communities of color would be most dramatically impacted, 
because they were unable to follow my basic advice of stay home 
and stay safe. They had to go to work. They had to put food on 
the table, and they were worried about their livelihood, and 
staying housed. And I think those are the challenges that we 
are trying to navigate as you think about social factors: How 
do we bring them together when issues around poverty and food 
insecurity all coalesce?
    So having resources, technical assistance, data to inform 
better and more efficient program delivery or community health 
worker support or linkages would be a tremendous asset, not 
only to emerge from the COVID pandemic but also to promote 
better health at local communities to really address the 
inequities that we have long known existed, so we could start 
to think about structural racism and the multilevel 
interventions that need to be developed and addressed.
    And we will have to do it collaboratively, with community 
voices, with stakeholders engaged from the start. Thank you for 
that question.
    Ms. Barragan. Thank you.
    Ms. Blauer, data from the CDC found that African Americans 
and Latinos were nearly three times more likely than White 
Americans to be hospitalized with COVID-19 and twice as likely 
to die from the virus. Factors such as a lack of insurance, 
limited access to healthcare services, working in occupations 
in which telework is not an option, and being more likely to 
face eviction and homelessness in times of economic instability 
are only some of the reasons these disparities exist.
    Unfortunately, there is a lack of complete, accurate, and 
standardized race and ethnicity data to help paint the full 
picture. The question is, what existing State and Federal data 
infrastructure should be used to ensure clinicians and health 
systems and health plans that are implementing programs to 
address social determinants of health have accurate and 
comprehensive data on patient populations who would most 
benefit from these programs?
    And where does the Federal Government need to make 
additional investments?
    Ms. Blauer. Thank you, Congresswoman. It is a very good 
question, and it is one that I have been thinking a lot about 
over the course of the last 17 months.
    We still are completely in the dark in really 
understanding, fundamentally, where populations had major 
obstructions to even accessing the very basic tools that they 
needed to navigate this pandemic, like testing and vaccine 
access. And that is because of the limitations on demographic 
data that has been paired with the release of COVID-19 
information.
    So first and foremost, there must be standardization and 
requirements on how data is collected and how data is shared 
from local authorities, health departments, State health 
departments to the Federal Government, and there needs to be an 
optimization of not only how that data is collected but how 
that data is broadly shared, so that local policymaking can 
align to where those needs are, so we can deploy the resources, 
so that people that are living in communities, particularly 
those that are disproportionately affected by health 
disparities, have equal access to the very tools that they are 
going to need to navigate not only this pandemic but the very 
real health challenges that are associated with navigating all 
of the social determinants of health that you have remarked on 
in your comments today. So thank you for the question.
    Ms. Barragan. Thank you so much.
    And thank you, Madam Chairwoman, for your patience, given 
the interruption. With that, I yield back.
    Ms. Eshoo. You are most welcome. Now, let's see if our 
friend Ms. Kelly is--I see her room on the screen, but I don't 
see her.
    Ms. Blunt Rochester. Madam Chairwoman, Ms. Kelly is in a 
dual committee, and so asked if I would----
    Ms. Eshoo. OK, all right. Then the Chair will go to 
recognizing the gentlewoman from Delaware, Ms. Blunt Rochester, 
for your 5 minutes of questions.
    Ms. Blunt Rochester. Thank you so much, Madam Chairwoman, 
for the recognition. And thank you to all the witnesses for 
being here today to discuss the important slate of bills at the 
intersection of data, health equity, public health 
infrastructure, and healthy outcomes.
    I also want to give a special thank you and recognition to 
Dr. Kara Odom Walker from Delaware. A phenomenal job, and thank 
you for being here today.
    I am also pleased to see two bills from the Black Maternal 
Health Momnibus Act being discussed today, and I look forward 
to having my colleagues support our bill, my bill. It is a 
bipartisan bill, the Moms Matter Act, H.R. 909, which is part 
of the Momnibus. The Moms Matter Act would make community 
investments to support moms struggling with maternal mental 
health and substance use conditions, and also grow the 
healthcare workforce in those sectors.
    We know that maternal mental health is deeply tied to and 
predicted by the social determinants of health. Given that next 
month is Black Maternal Mental Health Awareness Month, I hope 
that the committee will consider this bill and the entire 
Momnibus.
    And Dr. Walker, could you share how--how would improving 
maternal mental health and the health of mothers impact the 
lifelong health trajectory of their children?
    Dr. Walker. Thank you, Congresswoman, and thank you for 
your leadership to our great State.
    I have to say that investing in maternal health, 
particularly around mental health, does have long-term impacts. 
We know that they are linked. We know that factors that happen 
early in preconception around trauma and stress during 
pregnancy and early postnatal care that--risk their own lives, 
but also that of their child. And it is a huge factor in how 
children develop.
    So maternal depression is linked to so many other outcomes 
for children: their economic success long term, their ability 
to succeed in school, the likelihood that they will access 
child care and early education. And I think what we know is 
that even things around preconception diet all have longlasting 
impacts.
    So if we can really think about the cognitive and 
behavioral development and the support of moms, making sure 
that we are looking at maternal depression can ultimately 
impact a generation, ultimately impact the well-being of the 
child. And I think what we have seen in COVID is that this 
issue is more important now, more than ever.
    Ms. Blunt Rochester. Yes. Well, shifting gears, Americans 
with lower incomes are frequent targets of tobacco industry 
marketing and often face financial and other stressors that can 
lead to continued tobacco use.
    As we know, tobacco use is a key driver of poor health 
outcomes and a major health equity concern. Medicaid enrollees 
use tobacco at more than twice the rate of those with private 
health insurance. Yet Medicaid tobacco cessation treatment is 
often less comprehensive than what private health insurance 
plans are required to provide.
    In addition, there are barriers such as copays and 
sometimes prior authorization or step therapy that can also 
impact the insurance types.
    Tobacco use also negatively impacts our Nation's children. 
More than half of all children with asthma get their coverage 
through Medicaid and CHIP, and exposure to secondhand smoke can 
cause asthma attacks. That is why I was proud to introduce the 
Quit Because of COVID-19 Act, H.R. 2125, which would expand 
comprehensive tobacco cessation coverage to all Medicaid and 
CHIP enrollees. Fundamentally, this bill is really about 
equity, giving Medicaid enrollees equal access to effective 
tobacco cessation treatment so that they can live healthy 
lives.
    And as we talk about recognizing and addressing social 
needs and improving health data systems, I can't help but think 
of Delaware's leadership as the first State to launch a 
statewide health information exchange back in 2007, the 
Delaware Health Information Network, otherwise known as the 
DHIN.
    And so, Dr. Kara Odom Walker, if you could, just speak a 
little bit about the opportunities to leverage clinical health 
information networks like the DHIN to strengthen our public 
health data and public health response to both pandemics and 
the social determinants of health.
    Dr. Walker. Thank you, Congresswoman. We know that health 
information exchanges make it easier to exchange clinical 
information for treatment, care coordination. All of the 
witnesses have talked about that interconnection. And we are 
very fortunate to have a statewide health information exchange. 
This would allow us to really think about an opportunity to 
expand HIEs' ability and strength to not just look at clinical 
data, but also how we leverage social determinants of health 
data, because they are interconnected and they are causal and 
they really do indicate the need.
    We really do need, as physicians, to think about the 
wraparound indicators around health, not just what is happening 
in that one-on-one patient encounter but what happens when they 
are home, when they are at church, when they are in their 
communities. And I must say that the pandemic has shown us that 
even more data integration across State lines is challenging. 
And so having the ability to share information in that way 
could be incredibly helpful for COVID. We needed that. We 
needed----
    Ms. Blunt Rochester. Thank you----
    Dr. Walker [continuing]. To create a response across the 
board.
    Ms. Eshoo. The gentlewoman's time----
    Ms. Blunt Rochester. Thank you, Dr. Walker.
    Ms. Eshoo [continuing]. Has expired.
    Ms. Blunt Rochester. Thank you, Dr. Walker.
    And I yield back, Madam Chairwoman.
    Ms. Eshoo. OK, let's see. We need a band to welcome her 
back.
    Are you there, Robin? There you are.
    Ms. Kelly. I am here. Can you hear me?
    Ms. Eshoo. Wonderful, all right.
    Ms. Kelly. OK.
    Ms. Eshoo. We are thrilled to recognize you for your 5 
minutes of questions.
    Ms. Kelly. Thank you----
    Ms. Eshoo. And all the----
    Ms. Kelly. Thank you, Chairman Eshoo and Ranking Member 
Guthrie, for holding this hearing to discuss how we can improve 
our public health data infrastructure to advance equity and 
address social determinants of health.
    The COVID-19 pandemic has highlighted the gaps in our 
public health data infrastructure but also provides an 
opportunity to better integrate and standardize data 
collection. Unfortunately, data on race and ethnicity continue 
to be incomplete across the public health system. This data--
these data are critical to identifying and addressing 
disparities in disease, prevalent healthcare access, and health 
outcomes. Addressing the social determinants of health is an 
important way to tackle health disparities.
    I applaud Congresswoman Bustos' work on the Social 
Determinants Accelerator Act, and Representative Pressley's 
Anti-Racism in Public Health Act. Too often, social 
determinants of health is used as a stand-in for addressing 
issues of interpersonal and systemic racism. So it is important 
to continue addressing racism in public health.
    Dr. Walker, how does racism and other structural inequities 
drive social determinants of health?
    And specifically in your experience, how does it affect the 
health of pregnant individuals and their infants?
    Dr. Walker. Thank you, Congresswoman. We know that social 
determinants of health matter. And in fact, you know, what we 
do in a medical setting is--about 10 percent of long-term life 
expectancy. And for that reason, many have written about it--
the National Academy of Medicine.
    Even at Nemours we were trying to figure out how to launch 
a social determinants of health screener to better understand 
all of the needs of the child. And we do that in pediatrics 
from day one of life, beyond. But what we know is that some of 
those predictors actually happen during the maternal period, 
during preconception, during the pregnancy. And so, if we can 
incorporate those same principles and strategies earlier on, we 
will have a chance to promote better health, long term.
    Ms. Kelly. Thank you. I would like to submit to the record 
``Addressing Racism and Socioeconomic Influencers,'' coauthored 
by the National Partnership for Women and Families and the 
National Birth Equity Collaborative, as part of their Saving 
the Lives of Moms and Babies series.
    Also, Dr.----
    Ms. Eshoo. So ordered.
    [The information appears at the conclusion of the hearing.]
    Ms. Kelly. What are the current gaps in maternal health 
data collection?
    Dr. Walker. We know that we have data gaps, and some of 
those data challenges are around just having accurate, 
reliable, standardized race/ethnicity data incorporated and 
geocoded at the local level. So having data dashboards is 
critically important. We are, at Nemours, trying to geocode 
information that we have. But we see differences by race, 
ethnicity in who reports their own information. And I think 
that is an opportunity to provide guidance, to provide 
technical assistance and really think about data standards to 
make it more informative and more useful, to allow the 
collaborations between public health agencies and health 
systems to better represent what is going on, and address those 
inequities in case.
    Ms. Kelly. Is it currently being collected by community 
organizations or the private sector that will be helpful to 
integrate with the clinical data, to better understand maternal 
health risk factors?
    Dr. Walker. Yes, it is being collected, but I think the 
challenge is that there often are gaps in what we have. For 
example, we have some information in our health record that 
isn't necessarily the same as what is in our health information 
exchange. And so there just is a process of making sure we are 
using the best data available, that we are using self-reported 
race/ethnicity, and that we are sharing that same information 
at the highest quality available with others who are trying to 
collaborate, and really address inequities.
    But it does take everyone. Otherwise, we are without that 
data and high-quality data. We are--our challenge in trying to 
overcome the barriers and leaving people out, particularly in 
communities of color.
    Ms. Kelly. Thank you, and I yield back.
    Ms. Eshoo. The gentlewoman yields back. I am glad it all 
got straightened out, and thank you, Robin, you are wonderful.
    The Chair is pleased to recognize the gentlewoman from 
Minnesota, Ms. Craig, for your 5 minutes. Thanks for your 
patience. We are thrilled you are on the committee.
    Ms. Craig. Well, thank you so much, Chairwoman Eshoo, and 
especially for holding this incredibly important hearing today. 
And thank you to all of our witnesses for being so patient with 
us and our very many questions, as well.
    I appreciate, especially, the focus on the drivers of 
health disparities: race, ethnicity, sexual orientation, gender 
identity, and social determinants of health like access to 
transportation and housing.
    I represent a district that is equal parts urban, suburban, 
and rural. And many folks living outside of the major cities 
don't have reliable access to in-person appointments with 
medical professionals. I was recently appointed to serve on the 
Select Committee on Economic Disparity and Fairness and Growth, 
where I will have an opportunity to address the economic 
inequalities faced by rural communities, disparities that have 
a direct impact on healthcare access and outcomes.
    I am also a proud cosponsor of many of the bills up for 
discussion today, including H.R. 2503, the Social Determinants 
Accelerator Act. Introduced by Congresswoman Bustos, this bill 
would create a program at CMS to provide grants to State and 
local governments to develop plans to combat social 
determinants of health that are negatively impacting health 
outcomes.
    With that, my first question is to Dr. Odom Walker.
    Rural residents in my district face long drive times to the 
doctor, and lack of high-speed internet. For instance, rural 
Minnesotans seeking inpatient mental health and chemical 
dependency treatment must travel three times longer than urban 
patients, on average. And many in my district have limited to 
no broadband access, making it very difficult to reach them via 
virtual healthcare. This lack of access undoubtably leads to 
worse health outcomes, and it is not an uncommon story in my 
part of Minnesota.
    How could the Social Determinants Accelerator Act, Dr. 
Walker, which invests in State and local capacity, help rural 
communities fight these factors that are leading to negative 
health outcomes?
    Dr. Walker. Thank you for the question, Congresswoman. I 
think it is unique, and one of the opportunities with the 
Accelerator Act is that--you invest at the local level to hear 
from stakeholders, hear from communities about their particular 
situation and needs.
    For example, maybe a strategy that could be invested is a 
telehealth kiosk that is at a local entity, a community center, 
something that is, you know, commonly available, to provide 
that telehealth and broadband access in a stable way. These are 
the kind of ideas that some have deployed, but it needs scale. 
It needs, you know, to do more of it where it works, because 
just putting telehealth into place doesn't necessarily overcome 
those challenges. And if you have to drive 3 hours to the 
doctor, that also is not necessarily addressing the challenges 
of rural communities.
    So really trying to figure out how to make it unique for 
the community that we are talking about and making sure that we 
are looking at the right lens, the right problem, and with the 
right data is really important in this bill.
    Ms. Craig. Thank you so much, Dr. Walker. My next question 
is for Dr. DeSalvo.
    I am a proud original cosponsor of the Black Maternal 
Health Momnibus Act, which includes H.R. 925, the Data to Save 
Moms Act. One provision of the Data to Save Moms Act would 
provide funding to promote representative community engagement 
within maternal mortality review committees, which are 
multidisciplinary committees in States and cities that perform 
comprehensive reviews of deaths during or up to 1 year after 
pregnancy.
    Dr. DeSalvo, why is it important to gather a diverse range 
of perspectives in maternal health data collection and 
reporting processes, including to the elevation of voices and 
experiences of people from communities most severely impacted 
by our Nation's maternal mortality crisis, particularly 
communities of color?
    Dr. DeSalvo. Thank you for the question, Congresswoman.
    We have an expression in public health that the work needs 
to be done with community, not to community. And that 
particular part of the Momnibus package describes that so well, 
that it is not just about experts looking at the data, people 
in medicine, or even public health professionals. It has to be 
done with community to understand what is being seen and how to 
identify appropriate interventions that are culturally 
appropriate, linguistically appropriate, and are going to meet 
the needs of the community.
    So that kind of engagement is essential, really, when we 
are tackling major public health challenges like maternal 
mortality, which is higher than any other high-income country 
and rising in the U.S., and particularly acute for communities 
of color.
    So the suite of bills not--really helps us understand. It 
is quantitative. It is the voice of community. And, as you have 
raised in the prior question, it is a multipronged approach. It 
is not just about great medical care. We have to make sure 
people have access to the social needs being addressed, as 
well.
    Ms. Craig. Thank you so much, Dr. DeSalvo.
    And with my time expired, Madam Chairwoman, I will yield 
back.
    Ms. Eshoo. The gentlewoman yields back. It is now a 
pleasure to recognize another one of the new members to our 
subcommittee in this Congress, one of the five women on the 
Democratic side of the aisle, the woman from Texas, Mrs. 
Fletcher.
    You have 5 minutes for your questions. Thanks for your 
patience.
    Mrs. Fletcher. Well, thank you so much, Chairwoman Eshoo, 
for holding this hearing. And thank you to all of our witnesses 
for sharing your testimony with us today. It is really 
thoughtful, really insightful.
    Social determinants of health has been an issue that people 
in my district in Houston have been concerned about, 
researching, talking about in ways that are constructive and 
useful. In fact, we had a town hall on this topic shortly 
before the pandemic, and several roundtable discussions. And so 
I just really appreciate the perspective that you brought 
today, because, of course, we have seen during the COVID-19 
pandemic that these issues affected outcomes across the 
country, as many of my colleagues have already discussed today.
    So I think what has been really useful today is making 
clear to all of us on the committee the need for data to 
address the deficiencies in our public healthcare system. We 
have a great slate of bills to really get at that. And I think 
it is, you know, not just data itself, but more inclusive data 
that takes into account the social determinants of health, as 
we move forward.
    And so, Dr. DeSalvo, I was really interested in your 
comments on creating a system with the community to collect 
data and address social determinants of health. And as we have 
seen from the COVID-19 vaccine rollout, for example, you know, 
as of earlier this month, I think June 7th, less than a quarter 
of Black Americans had received their first shot. And there is 
a considerable amount of mistrust in the healthcare system 
among minority populations. And this can be a huge barrier for 
people getting the care that they need.
    So from your experience, how can we collect health data in 
a way that engages impacted communities to better address their 
needs?
    Dr. DeSalvo. Thank you for the question, Congresswoman, and 
just to acknowledge Houston as a place that has done some great 
work in multisectoral collaboration. And so you all do know how 
to address social determinants in a public-private-sector 
fashion.
    With respect to seeing the data and being able to act on 
it, I will give you some examples that relate to public-private 
sector coordination and ways, certainly, that we at Google have 
been thinking about partnering, particularly with academics.
    Early in the pandemic it was clear that there needed to be 
more understanding of how COVID-19 was disproportionately 
impacting communities of color. We worked with Morehouse, with 
the David Satcher Institute, to develop a COVID equity tracker 
that will also be able to now report out on other inequities or 
disparities in related diseases, like diabetes. So it is an 
opportunity for us to not only help them with data, but to help 
build technical capacity that can support public health 
decision making.
    Another more recent example, since you raised vaccines, is 
work that we have done with the Harvard Medical School and 
Ariadne Labs, again, to not only provide data insights but 
provide technical assistance and partner with them so public 
health departments, healthcare systems can see where there are 
vaccine deserts. Who needs extra help getting to a vaccine? 
Should we put up a popup clinic on this corner to reach more 
people? Those are ways where everybody together can really 
begin to meet people where they are to get them the services 
that they need.
    Mrs. Fletcher. Terrific. Well, thank you for that, and I 
want to move on with the time I have to talk about another 
issue, which is that many public and nonprofit safety-net 
hospitals serve large populations of low-income and diverse 
patients, and they are challenged by numerous social risk 
factors. And some have come together to share and innovate on 
best practices. And, you know, I have seen that in Houston, 
especially--you know, we have a really good collaboration, and 
I think that is a part of how we do things in Houston. But they 
often lack data platforms that track both medical and social 
conditions and facilitate access to services that respond to 
those needs.
    So, Dr. Walker, in the time I have left I want to talk 
about your testimony. You talked about the fact that public and 
community-based organizations haven't been given the same level 
of investment as other healthcare organizations. Would you 
agree that investments for data platforms and safety net 
providers who often struggle under difficult financial 
circumstances could drive progress in addressing health 
inequity?
    Dr. Walker. Absolutely. I think data informs strategy. And 
without that data, we are often leaving people out, leaving 
individuals and populations out, and have an incomplete picture 
of where we need to deploy public health resources or make 
policy decisions, which, underlyingly, has been the challenge 
with exacerbating disparities.
    I think that there is another benefit--in the seconds I 
have--just to have data available as a common good, instead of 
having disparate organizations, health systems and others 
trying to piece it together.
    Mrs. Fletcher. Wonderful. Well, thank you so much.
    And I am almost out of time, so I want to thank you again, 
Chairwoman Eshoo, for holding this hearing. I am so supportive 
of the legislation that we have covered today, and I am 
grateful for the chance to learn more from this wonderful panel 
of witnesses. Thank you so much, and I yield back.
    Ms. Eshoo. Thank you. Now I--let's see. Oh, another one of 
our wonderful doctors, the gentlewoman from Washington State, 
Dr. Schrier.
    You have 5 minutes for your questions.
    Ms. Schrier. Well, thank you, Madam Chair, and thank you to 
all the witnesses who spoke today.
    Dr. Walker, I am so intrigued by the endless possibilities 
that data sharing and interoperability offer to improve 
childhood outcomes. So, from the perspective of a pediatrician, 
I think, wow, it would be really helpful to know which of my 
patients qualify for free and reduced lunch at school, because 
that could help guide me in conversations about nutrition and 
financial stressors, housing, whether the parents have the 
bandwidth or the resources to help their kids in school. It 
would even help me focus on community resources like story time 
at the library.
    It would also be really helpful to know which of my 
patients rely on WIC and SNAP, since poor nutrition is 
associated with adverse behavioral and academic outcomes but 
also with tooth decay. And so I could use that knowledge in the 
clinic to, say, apply fluoride to all my patients' teeth, as 
opposed to just hoping that they will follow through and see a 
dentist.
    I would imagine that this kind of information would be 
really helpful for teachers, as well, to know which of their 
students are homeless or relying on social services.
    So my question for you, Dr. Walker, is how do parents feel 
about data sharing between public health, social services, 
schools, and doctors?
    Dr. Walker. Thank you so much for that question, and I 
often think of the context of families and how, as physicians, 
we are often limited by not having the entire picture. And if I 
knew that a student wasn't doing well in school, in that 
clinical interaction I could ask whether they have been tested 
or need to be retested for vision screening or have a hearing 
test, and whether that is a promoter.
    But I do think that the issue of trust in data sharing is a 
real one, and one that we are always careful in navigating. But 
with the right support, the right technical assistance, we 
could make sure that we have the right data analytics in a 
protected environment and allow us to think about how to do 
this in the right way, learn from those early adopter States 
that have already figured some of this out, like Oregon and 
some that we have mentioned earlier, North Carolina----
    Ms. Schrier. Right.
    Dr. Walker. And then some of----
    Ms. Schrier. And I think that brings me----
    Dr. Walker [continuing]. That innovation.
    Ms. Schrier. Thank you. I think that brings me to my next 
question for Dr. DeSalvo.
    First, I just want to thank you for your work on the app 
that we use in Washington State that was developed by Google in 
combination or in partnership with our department of public 
health so that, if you have got your phone with you and you are 
near somebody with a positive COVID test, it notifies you.
    And so, given that experience with public-private 
partnerships and with privacy, I was just wondering, when we 
talk about kind of a relationship between schools and social 
services and public health and doctors' offices, how do you 
address privacy issues related to that kind of data sharing 
that would help patients and would--yes, how would you address 
the privacy issues?
    Dr. DeSalvo. Yes, Congresswoman, thank you so much for 
raising the question. And I will echo what Dr. Walker shared, 
which is--I am an internist. And always, we want to know more 
about the home context or the social context to understand if 
that is what is, you know, driving some of the--uncontrolled 
diabetes, as an example.
    I think what I have learned from not only patients, but 
what people tell you in focus groups and surveys, and you 
being--when the National Partnership for Women and Families 
does surveys, or the--or when we did the--met the office of 
national coordinator--is people want to know that they can have 
some sense of knowledge about who has access to their data. 
That is the transparency part. And they very often--people they 
trust. They just need to know that they have some control over 
how that happens.
    And the--in this space that you are describing, which--I 
mean, technically, some of those entities fall outside of 
HIPAA--there has been a lot of work in thinking about how, as 
we are going to--as a healthcare system, and a public health 
system, be more inclusive of data, give consumers that choice 
and control----
    Ms. Schrier. That makes sense.
    Dr. DeSalvo [continuing]. Sharing.
    I will just call out the particular place that provides 
the--that has been doing the thinking on it. It is a group 
called the CARIN Alliance, not as in my Karen, but C-A-R-I-N, 
working with consumers and others to understand content.
    Ms. Schrier. Thank you. One more question for you. There's 
a lot of what-ifs about COVID and how we handled it, what could 
have gone better. And I think about whether, you know, if we 
had a really modernized, interoperable, digital, wonderful 
health infrastructure, if we could have used, say, wastewater 
testing for COVID in order to really direct our public health 
response, and now we are talking about tracking COVID-19 
variants in a--in one of the bills being discussed today. How 
could an optimally situated public health department use data 
about new variants to curb spread of disease?
    Dr. DeSalvo. In a few seconds, just to say what was 
desperately missing for public health was not only the now, 
casting the data that Dr. Blauer was able to provide the 
country, but the opportunity to forecast and be able to predict 
what--where the virus was going to spread and where variants 
would spread into the future.
    We have partnered to create a system called Global.Health 
with Global Public Health to begin to advance that work in 
forecasting. But the bills that you have before you, the kind 
of work that Congress is doing, is thinking about not just the 
data but the infrastructure and the people who work on that 
data around it. So it has got to be a system in order to 
prevent the kind of outcomes that we had in this last pandemic.
    Ms. Schrier. Thank you very much.
    I yield back.
    Ms. Eshoo. The gentlewoman yields back. I am getting a kick 
out of myself saying ``yields back,'' because I have let so 
many Members to go way over. So they really don't have any time 
to yield back, but we have accommodated everyone. I hate to cut 
people off, because everything, every question and answer, is 
just so important to us.
    And now, last but certainly not least, a real value-added 
new member to the committee, the gentlewoman from 
Massachusetts, Congresswoman Trahan.
    You have 5 minutes for your questions.
    Mrs. Trahan. Well, thank you----
    Ms. Eshoo. How about 5\1/2\?
    Mrs. Trahan. The joys of going last, I get a little extra 
time. No, thank you, Chairwoman Eshoo. And thank you to all the 
witnesses here today. It has been so informative.
    There is no question public health data is multifaceted, 
and it resides in different agencies and institutions that span 
across, you know, social services, education, behavioral 
science, and so much more. And improving data collection and 
closing those gaps is critical to our not only addressing the 
ongoing COVID-19 pandemic but all of our other public health 
challenges.
    You know, in 2015 my home State of Massachusetts recognized 
the value that data innovation has in inadequately--excuse me, 
in adequately addressing public health crises and passed 
Chapter 55, a law which authorized the Massachusetts department 
of health to link multiple, traditionally siloed data sets with 
insight into the opioid crisis, an approach that had never been 
before sort of cross-studied. And the reports and underlying 
analysis drew insight from a database that linked mental health 
data, jail and prison data, vital records, you know, substance 
addiction treatment data, ambulance and counter information, 
the States' all-payer claims database, and others. And based on 
all those insights from Chapter 55, the reporting and the data 
visualizations, measures like limiting first-time opioid 
prescription to 7 days, a first-in-the-Nation measure, was 
signed into law.
    So in 2017, when opioid-related overdose deaths fell for 
the State population as a whole, data showed it rose by 44 
percent for Black males. And this data led the health 
department to develop a community-based public awareness 
campaign to focus on and reach Black men.
    So you know, Dr. DeSalvo, I will start with you. Can you 
just speak once again to how cross-departmental sharing of 
information can be used to drive policy to combat public health 
crises in the country, such as the opioid epidemic?
    Dr. DeSalvo. Yes. Thank you so much, Congresswoman, for 
reminding all of us that bubbling under the surface is another 
epidemic that was here prior to the pandemic and is beginning 
to reemerge. So we have to, when we are thinking about building 
public health data systems, we have to remember they need to be 
useful not only for communicable disease but for other 
conditions that affect communities, opioids being a great 
example in Massachusetts, in this case, as in others.
    It has been smart about leveraging multiple data sources 
that tell the story of a person's health or a community's 
health beyond just the healthcare episode. You are describing 
data sources that describe there are social and human services 
interactions, as well as their healthcare needs. And all of 
that will be necessary, if you are going to take a multipronged 
approach to developing community interventions to drive equity 
and address social determinants as well as medical needs and 
then measure the outcomes, as you describe.
    So a takeaway for me from that lesson you all have been 
teaching the country is multiple sources of data needed to tell 
the story of somebody's health or needs, and take action in a 
multipronged way at the community level and know if we are 
making a difference in outcome. And we need to build those 
systems to be agile, so they can address the multitude of 
community needs that are there on the front lines.
    Mrs. Trahan. Thank you. You know, one other thing that was 
made clear to me is that, in order to collect robust data to 
tackle these public health crises, we must heavily invest in 
both public health infrastructure and workforce in the field of 
data and informatics.
    And over the years, researchers have discovered a large 
variety of human biases that shows the things that people 
understand or believe do not always reflect what is actually 
happening in the real world.
    And so, question for you, Dr. Walker: Could you just speak 
to how investing in a diverse pipeline of individuals and 
health data analytics can work to mitigate, you know, 
unconscious bias in the analysis of data that drives our 
policies?
    Dr. Walker. Thank you for that question. I think having a 
diverse workforce is--allows you to interpret the data in the 
right way. But I would also say it is not just about the 
professional workforce. It is also trying to figure out how to 
have community and stakeholders involved in that data 
interpretation stage.
    So thinking about piecing together information, whether it 
is for the opioid pandemic or other inequities, we know that 
bringing them together is critically important and requires an 
investment of expertise, but also of what you do with it and 
how you put it out to the world, whether it is a data dashboard 
that we found incredibly valuable in the past year and a half, 
or whether it is putting it in the hands of local community 
advisory boards who can say whether, for their community, it is 
more important to have broadband investments or to think about 
transportation.
    So I think it is essential, and we just have to figure out 
where to----
    Mrs. Trahan. Yes. Well, thank you. And making that data 
consumable is job number one, so we know how to act on it.
    So I am out of time, even though the chairwoman was 
gracious enough to give me a little bit more. So thank you so 
much for all of your input today. It is very helpful in our 
policymaking.
    I yield back.
    Ms. Eshoo. The gentlewoman yields back.
    Well, we have come to a conclusion of all of this time with 
Members asking their questions. I want to thank each one of the 
witnesses.
    You have been with us for a long time today, almost 4 
hours--20 minutes shy of 4 hours. So I hope you had breakfast, 
because you certainly have missed lunch.
    Dr. DeSalvo, Dr. Batra, Ms. Blauer, Dr. Syed, and Dr. 
Walker, you have all been terrific.
    Now, Members have 10 business days to submit additional 
questions for the record. So witnesses, we are asking you to 
please respond as promptly as possible to the written questions 
that are going to be submitted to you.
    And now I want to go to my friend, the ranking member of 
the subcommittee, Mr. Guthrie, because we have 23 documents to 
be submitted into the record, and I would like to request 
unanimous consent, but I need your consent.
    Is Mr. Guthrie with us?
    Mr. Guthrie. Our side consents.
    Ms. Eshoo. There you are. Thank you very much.
    All right. So there is unanimous consent to enter the these 
documents into the record, and I think that is it.
    [The information appears at the conclusion of the hearing.]
    Ms. Eshoo. So thank you, everyone. Bravo to each one of the 
witnesses. It was a terrific hearing.
    And we are going to move these bills. We have 13 today, in 
this legislative hearing. I think 6--I think there are 6 or 7 
that are bipartisan. So we are always pleased and proud about 
that.
    But all of them are a reflection of the very important work 
of many Members of Congress in writing the legislation and 
having our subcommittee have the honor of having a legislative 
hearing.
    So God bless all of you. God bless our country. Thank you 
for being witnesses.
    And the Subcommittee on Health will now adjourn.
    [Whereupon, at 2:12 p.m., the subcommittee was adjourned.]
    [Material submitted for inclusion in the record follows:]

               Prepared Statement of Hon. Richard Hudson

    I want to thank Chairwoman Eshoo and Ranking Member Guthrie 
for holding this important hearing today, and thank our expert 
witnesses for their time and testimony.
    As you may recall, last summer, I requested a hearing on 
the disparate impact COVID-19 was having on our minority 
communities, to which this Committee responded and held one. I 
am pleased we are reexamining this issue, particularly in the 
context of how we can work toward solutions by examining social 
determinants of health and the data associated to correctly 
address the issues raised.
    I think we all can agree that minority communities are and 
have been experiencing gaps in access and health outcomes. This 
problem has been further emphasized during the COVID-19 
pandemic. There is no question that across the Nation, there 
remains alarming data of the disproportionate impact the 
Coronavirus pandemic has had on our minority communities.
    Fayetteville, North Carolina, in my District, has a large 
and diverse community. At one point during the pandemic, I 
heard from leadership at a local hospital, Cape Fear Valley 
Medical Center that, while African Americans made up 57% of 
their COVID-19 patients, Cumberland County, where Fayetteville 
is located, is only 34.9% African American.
    These inequitable outcomes are not just isolated to COVID-
19. I continue to hear from my District about how the 
differences and lack of access to medical, economic, 
educational, and community resources leads to disproportionate 
outcomes.
    Unfortunately, this is not localized to my District--this 
is a national and global issue, and we must not continue to 
settle for the status quo.
    We must be looking at avenues to address the impact of 
social determinants of health, including some of the bipartisan 
bills discussed today.
    I would particularly like to emphasize the importance of 
further enabling and promoting private sector innovation. I 
believe this can effectively be accomplished by continuing to 
incentivize public-private partnerships. This is an area I have 
focused on this Congress, and I look forward to working with my 
colleagues on this Committee to engage and bring forward 
bipartisan solutions.
    I also agree with many of the witnesses and my colleagues 
today who have noted the need for more data. Data will help us 
dive deeper into the issues--allow us to effectively, 
efficiently, and appropriately conduct analyses, comparisons, 
and juxtapositions--to better inform not only us as 
policymakers, but the folks on the ground who are taking steps 
every day to work towards more equitable outcomes.
    With that being said--I also think this data must be 
collected and examined in modern and responsible ways. We 
cannot solve this problem by creating additional bureaucracies 
and duplicative programs. Our health systems already have 
enough on their plate.
    We should ensure the initiatives we are proposing are 
streamlined and straightforward to implement, particularly in 
this constantly evolving technological area.
    Again, I greatly appreciate the discussion today, and am 
committed to working with my colleagues on the Health 
Subcommittee to address healthcare inequality and the racial 
disparities in our healthcare system.
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