Archives     Advertise     Editorial Calendar     Subscribe     Contact Us    


Accounting for Social Risk Factors in Value-Based Payment


 

Healthcare providers are becoming more responsible for ensuring the efficiency and quality of the care they provide to Medicare beneficiaries. The shift toward value-based payment models means that measurements of efficiency and quality of care are increasingly used to determine financial bonuses and penalties.

A recent report by a committee of the National Academies of Sciences, Engineering, and Medicine (NASEM, formerly the Institute of Medicine) --on which one of us served --finds benefits of adjustment of such measures for both clinical and social risk factors. Clinical risk factors are physiological attributes that can be associated with increased risk of certain diseases and health outcomes: they are already used to adjust quality and efficiency measures. Social risk factors are patient attributes such as low socioeconomic position, minority race or ethnic background, minority sexual orientation or gender identity, or living in a deprived setting.

Research has shown that these social risk factors influence health-related outcomes: patients with these attributes have worse health outcomes, and providers that disproportionately serve them appear to, as well. If they are not measured and adjusted for as clinical risk factors are, providers who serve disadvantaged populations could be unfairly penalized.1 In addition, providers might work to reduce the effects of social risk factors but doing so could require additional staff effort and costs. If social risk factors beyond providers' control are not accounted for, and providers serving disproportionate numbers of patients with high degrees of social risk are penalized, then disparities in health outcomes could widen.

Thus, in order to achieve the goal of accounting for social risk factors in Medicare payment programs and compensating providers fairly, the NASEM committee was commissioned to "specify criteria that could be used in determining which socioeconomic status factors should be accounted for in Medicare quality measurement and payment systems."1 The committee found that these goals could be reached with a combination of approaches. Specifically, depending on the measure and context, a combination of approaches might be used to account for social risk factors without masking real differences in performance. The approaches are:

  • Stratified public reporting by social risk factors within reporting units to illuminate how providers serve those with risk factors.
  • Adjusted performance measures to standardize estimates of quality.
  • Direct adjustment of payments to providers who disproportionately serve those with social risk factors.
  • Restructured payment incentives to reward improved quality or high-value care.

The committee also found that development of new data sources and methods of measurement would be beneficial in identifying indicators of social risk. Table 1 shows the five major categories of measures considered important by the committee, and specific examples of measures in each category, which may be ready for use. One example is that data are ready for use on dual eligibility for Medicare and Medicaid (an indicator of low income), and the Medicare program could use them to adjust measures of - and penalties for - hospital readmissions.


In addition, work to improve the accuracy of social risk data and use it for payment and quality measurement would likely benefit providers and patients in Nashville.1,2 Davidson County's poverty rate is higher than the U.S. average, and Nashville has a higher proportion of citizens who are members of minority races and ethnicities. 3 Accounting for social risk factors that a significant numbers of Nashvillians face would not only benefit the providers who serve these disadvantaged populations, but those directly affected by social risk factors themselves.

1 National Academies of Sciences, Engineering, and Medicine, Accounting for social risk factors in Medicare payment. Washington, DC: National Academies Press, 2017.

2 Buntin, MB, Ayanian, JZ. Social Risk Factors and Equity in Medicare Payment. NEJM. 2017 Feb 9; 376:607-510.

3 People Living Below Poverty Level by Race/Ethnicity, Nashville TN. HealthNashville.org (2015). Retrieved: March 9, 2017, from www.healthynashville.org Data Source: US Census Bureau, American Community Survey. 2011-2015.


Melinda Buntin, PhD is a Professor of health economics and the Chair of the Department of Health Policy at Vanderbilt University's School of Medicine. More about her Department can be found at https://medschool.vanderbilt.edu/health-policy/ or by following @VUHealthPol.





Aiden Lee is a senior at Vanderbilt University studying Medicine, Health, and Society with a concentration in Health Policies and Economies.








 
Share:

Related Articles:


Recent Articles

THA Honors 26 Hospital Leaders at Annual Meeting

Tennessee Hospital Association (THA) today honored 26 hospital administrators, employees and volunteers during its 2018 Annual Meeting. The awards luncheon was held at the Franklin Marriott Cool Springs.

Read More

AMA Announces Playbook to Successfully Adopt Digital Health

Best practices based on lessons learned from multiple sources are combined into an authoritative resource

Read More

PYA Publishes New White Paper: "Urgent Care Centers: A Solution to Overuse of Hospital Emergency Rooms--Valuation Considerations"

PYA, a national management consulting and accounting firm, recently released a white paper that offers insights on valuation considerations related to urgent care centers.

Read More

Corker: PEPFAR Reauthorization Bill Passes Committee, Extends Successful U.S. Program to Combat HIV/AIDS

U.S. Senator Bob Corker (R-Tenn.), chairman of the Senate Foreign Relations Committee, today praised committee passage of legislation he authored with U.S. Senator Bob Menendez (D-N.J.) to extend the President's Emergency Plan for AIDS Relief (PEPFAR) for another five years.

Read More

TDH Issues Public Health Advisory On Cannabis

Evidence, Known Harms Increase Concerns about Risks to Health

Read More

HHS Secretary Addresses Nashville Health Care Council Audience

On Thursday, Sept. 27, Health and Human Services Secretary Alex M. Azar II flew to Nashville to share thoughts and updates on healthcare coverage in America during a Nashville Health Care Council Event held at Lipscomb University.

Read More

The War Against Opioids in Pain Management

Awareness, innovative therapies are effective tools to manage pain and ward against addiction.

Read More

Designed to Disinfect: The Relation Between Interior Design & Infection Control

About one in 25 patients in America has at least one healthcare-associated infection (HAI) on any given day, according to the most recent statistics from the Centers for Disease Control and Prevention.

Read More

Physician Spotlight: Changing Minds

Acadia Healthcare CMO Michael Genovese, MD, JD, tackles misconceptions around mental health and addiction.

Read More

Addressing the Gap Between Need & Access in Treating Addiction

Need far outstrips capacity when it comes to treating substance abuse disorders. American Addiction Centers CMO Dr. Lawrence Weinstein discusses barriers to care and possible solutions.

Read More

Email Print
 
 

 

 


Tags:
Aiden Lee, Melinda Buntin, Quality Care, Risk Adjustment, Social Determinants of Health, Social Risk Factors, Value-Based Reimbursement, Vanderbilt University School of Medicine, VUMC
Powered by Bondware
News Publishing Software

The browser you are using is outdated!

You may not be getting all you can out of your browsing experience
and may be open to security risks!

Consider upgrading to the latest version of your browser or choose on below: