Accounting for Social Risk Factors in Medicare Payment

Recent health care payment reforms aim to improve the alignment of Medicare payment strategies with goals to improve the quality of care provided, patient experiences with health care, and health outcomes, while also controlling costs. These efforts move Medicare away from the volume-based payment of traditional fee-for-service models and toward value-based purchasing, in which cost control is an explicit goal in addition to clinical and quality goals. Specific payment strategies include pay-for-performance and other quality incentive programs that tie financial rewards and sanctions to the quality and efficiency of care provided and accountable care organizations in which health care providers are held accountable for both the quality and cost of the care they deliver.

Accounting For Social Risk Factors in Medicare Payment is the fifth and final report in a series of brief reports that aim to inform ASPE analyses that account for social risk factors in Medicare payment programs mandated through the IMPACT Act. This report aims to put the entire series in context and offers additional thoughts about how to best consider the various methods for accounting for social risk factors, as well as next steps.

Table of Contents

• Front Matter
• Summary
• 1 Introduction
• 2 Social Risk Factors: Definitions and Data
• 3 Methods to Account for Social Risk Factors
• 4 Moving Forward
• Appendix A: Identifying Social Risk Factors
• AS: Summary
• A1: Introduction
• A2: Social Risk Factors
• AA: Overview of Medicare Value-Based Payment Programs
• Appendix B: Systems Practices for the Care of Socially At-Risk Populations
• BS: Summary
• B1: Introduction
• B2: Improving Care for Socially At-Risk Populations
• BA: Example Implementation Strategies and Case Studies
• Appendix C: Criteria, Factors, and Methods
• CS: Summary
• C1: Introduction
• C2: Criteria for Selecting Social Risk Factors for Application in Medicare Quality Measurement and Payment
• C3: Applying Selection Criteria to Social Risk Factors and Health Literacy
• C4: Methods to Account for Social Risk Factors in Medicare Value-Based Payment
• CA: Criteria for Selecting Risk Factors Reviewed by the Committee
• Appendix D: Data
• DS: Summary
• D1: Introduction
• D2: Potential Data Sources
• D3: Data Sources and Data Collection for Social Risk Factors
• Appendix E: Prior Conclusions and Recommendations
• Appendix F: Committee Biosketches
• Index

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