Years ago, General Motors used to proclaim Chevrolet as the “heartbeat of America” while the financial community proclaimed Wall Street as the center of their universe. I have always contended that the real “heartbeat” and financial impact centers in America are located on Security Blvd., an obscure street just outside of Baltimore, Maryland. Situated on this road, less than 3 miles apart, are two Federal agencies that play a bigger economic and emotional role for Americans than anything comparable. They are, of course, the Social Security Administration (SSA) and the Centers for Medicare and Medicaid Services (CMS). Social Security payments are now 4.9% of GDP while Medicare is 3.7%. SSA’s programs give out payments to over 63 million Americans, including 10 million on disability. Both agencies touch the lives of virtually every American or their family. I was fortunate enough to spend almost 15 years of my career working for the two agencies and saw firsthand the dedication of the government and contractor staff supporting their great missions.
When we look for Federal government agencies engaged in healthcare, one immediately thinks of CMS, the other major HHS operating divisions such as the CDC, NIH, and FDA, and then the military or military-related agencies such as VHA, DHA, and Tricare.
SSA is not usually described as a healthcare agency yet its impact on the American healthcare system is considerable. Let’s briefly touch on several key roles that SSA plays.
- SSA handles most of the field work for Medicare including enrollment and processing Medicare premiums as part of the Social Security check. This is a natural outgrowth of Medicare initially being part of SSA.
- According to SSA’s website, as part of the disability determination process and continuing reviews, they “request close to 15 million medical records from almost 500,000 providers to make decisions on about three million disability claims annually.” Because of this workload, SSA became an early supporter of the Office of the National Coordinator’s (ONC) work on promoting the electronic transmission of medical information and continues today to work with HL7 and other national HIT standardization efforts.
- Death Notifications– SSA runs the Death Master File (DMF), which is used by Federal agencies, specially CMS and other benefits agencies, to get official death information on an individual. As noted by SSA’s OIG, in July 2017 Audit Report, “SSA receives death reports from a number of sources, including friends and relatives of the deceased and funeral homes. SSA also receives death reports from State Bureaus of Vital Statistics as well as from other Federal agencies. Additionally, other Federal agencies, the public, and private industry use SSA’s death information to identify deceased individuals. For example, SSA provides death information, including State death records, to Federal benefit-paying agencies to prevent payments to deceased individuals.” SSA works closely with HHS’ National Center for Vital Health Statistics and other Federal agencies, who use the information on the death record to gather information regarding mortality trends and other health data.
As you can see, SSA is a key participant in the healthcare ecosystem, although somewhat more indirectly than CMS or VHA. As the healthcare world begins to factor in the impact of social determinants on health, the potential role of SSA should not be minimized. As described in a 12/1/17 New England Journal of Medicine article, social determinants of health include a whole host of factors including income, education, living conditions, access to transportation, etc. While SSA is not directly involved in most of these factors, SSA’s integral connection with so many people in challenging social conditions could be a key conduit to both gather more information and explore ways to provide better community healthcare support. For example, a recent study showed that more than 20% of SSDI recipients were chronic opioid users. Also, many retired Americans rely heavily (completely in some cases) on their monthly social security check as their sole source of income. As Federal policymakers continue to explore how to integrate social determinants of health into payment and care models, SSA should be part of the conversation. As the only Federal agency that tracks each of us from birth to death, SSA must help drive healthcare change in this country. Together with CMS, they can turn Security Blvd into the healthcare center of America.