Accounting for Social Risk Factors in Medicare Payment (2017) / Chapter Skim
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Pages 549-568
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From page 549... ...
514-515 Patient Safety Indicator, 116, 120, 128, Medicare Shared Savings Program, 110, 135, 150, 208, 209 128-129, 135-136, 209-210, 326, Alliance of Community Health Plans, 222, 412-413, 415, 416 233, 243, 303 Next Generation, 327, 415, 416-417 Ambulatory care provider risk, 24-25, 125, 335 End-Stage Renal Disease Quality reducing readmissions, 289, 291 Improvement Program, 110, safety-net, 278 130-131, 136-137, 211-212, 326, unintended consequences, 219, 229 412-413 Acculturation Medicare Shared Savings Program, 110, community context, 383 128-129, 135-136, 209-210, 326, data sources and collection, 377, 395, 412-413 512, 526-527, 539 Physician Value-Based Modifier, 136, defined, 57, 375, 467, 512 210-211, 326, 412, 415 duration in United States and, 57, 58, race and ethnicity and, 172 375-376, 512 value-based payment (VBP) programs, and health and health care, 57, 176, 135-137, 209-212 319, 376, 383, 467-468, 511-512 American Community Survey language proxy for, 57, 58, 376, 392, area-level data, 10, 38, 49, 52, 57, 63, 512, 526, 527 65, 460, 465, 467 measures, 57, 58, 319, 375-376, 394, description, 489 512 education data, 52, 465, 506, 520, 521 nativity proxy for, 57, 175, 376, 394 housing data, 65, 460, 467, 511, 526 race and ethnicity and, 58, 376, 394- income data, 49, 460, 465, 505, 507, 395, 512 520, 521 recommendation, 467, 511-512, 539 549
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From page 550... ...
353, 445, 448, 482-483, 519, 520 clinical risk adjustment model, 101, Costs of care (see also Resource use, 132-133, 136, 213, 348, 445-449 defined) Home Health Outcome Assessment educational attainment and, 164 Information Set, 61, 510 health literacy and, 121, 160, 190, 191, Innovation Center, 26 388 Office of Minority Health, 57, 503 income and, 118, 164, 351 Strategic Language Access Plan, 56, 502 language proficiency and, 174 Clinical processes of care marital/partnership status and, 120, community composition and, 120 379 dual eligibility and, 372 Medicare quality measure examples, education and, 165 116, 150 gender identity and, 119, 178, 220 nativity and, 176 health literacy and, 121, 160, 191, 268, race and ethnicity and, 119, 121, 173, 281-282, 388 191-192, 374 income and, 118, 162, 164, 184-185, urbanicity/rurality and, 121, 189, 385 367 Critical access hospitals, 27, 220-221, 233, language proficiency and, 119, 173- 237, 239, 335-336, 418, 486 174, 175 Cultural competency training, 264-265 living alone and, 120, 180, 380
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From page 551... ...
538 acculturation, 377, 395, 512, 526-527, housing, 65, 386, 398, 458, 460, 467, 539 484, 489, 496, 508, 510-511, 526, accuracy considerations, 10, 37, 38, 539 39, 40, 48, 101, 353, 457-458, 461, imputed data, 56, 57, 464, 469, 502, 462, 496, 498, 526 503, 515, 518, 519 alternative government sources, 7-8, income, 48-49, 162-163, 367, 460, 465, 38, 459-460, 488-490 (see also 469, 481, 487, 488, 501, 504-505, American Community Survey; Social 507, 514, 520-521, 523 Security Administration) language barriers, 7, 10, 38, 56-57, approach to collecting data, 149-151, 100, 271, 319, 375, 458, 459, 463 469, 471, 514-530 464, 468, 469, 481, 483, 484, 485, area-level measures as proxies for 502-503, 514, 517, 518-519, 526, individual-level constructs, 10, 38, 527, 538-539 49, 52, 57, 62-63, 100, 120, 181- living alone, 61, 466, 508, 509-510, 184, 383-384, 459, 460, 465, 488, 524-525, 539 489, 503, 505, 506, 507, 520, 521 marital/partnership status, 60, 463-465, burden and cost of collection, 7, 10, 37, 501, 503-504, 520-521, 538, 539 38, 39, 54, 57, 62, 100, 101, 320, national surveys (other than American 352, 353, 360, 382, 386, 388, 401, Community Survey [ACS]
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From page 552... ...
552 ACCOUNTING FOR SOCIAL RISK FACTORS IN MEDICARE PAYMENT sample size considerations, 446, 447, as income proxy, 52, 68, 100, 117, 161, 448, 484, 488, 489, 490, 507, 528 371, 372, 390, 392, 500 self-identification and self-reporting, 38, and patient experience, 372 48, 53, 55, 56, 58, 129, 166, 167, recommendation, 463, 499, 538 169, 175, 238, 367, 370, 374, 377, and utilization of health care, 163, 164, 380, 457, 464, 466, 469, 481, 502, 273 504, 508, 512, 515, 519 value/stability as indicator, 48, 68, 100, sexual orientation, 10, 59, 68-69, 324, 117, 319, 326, 371-372, 373-374, 378, 467, 468, 485, 488, 511-513, 389, 390, 457, 479, 495, 536 528-529, 539 as wealth proxy, 52, 53-54, 68, 371, Social Security Administration, 10, 38, 372, 500, 509, 522 49, 57, 58, 459-460, 463, 465, 469, 488-490, 500, 504, 505, 514, 516, 517, 519, 520, 521 E social support, 62, 466, 467, 508, 510, 524-525, 539 Education standardization issues, 10, 38, 49-50, and clinical processes of care, 165 52, 55-56, 57, 59, 60, 61, 62, 100, and costs of care, 164 251, 271, 305, 374, 393, 457-462, data sources and collection, 10, 37, 49, 464-468, 481-486, 488, 489, 497, 52, 100, 112, 458, 463-464, 468, 499, 502, 503, 505, 506, 510, 513, 469, 483, 484, 505-506, 520-521 518-522, 524, 526, 528, 529 and health and health care, 49, 118, statement of task, 456-457, 476-477, 161, 164, 165, 183, 284, 373, 383, 478 391, 392, 465, 505-506 urbanicity/rurality, 64, 100, 463, 499, and health literacy, 12, 49, 69, 325, 501, 506, 516-517, 523, 538 387-388 wealth, 508-509 and income, 48, 49, 118, 162, 164, Disability 367, 373, 465, 504, 506 built environment and, 187 interventions by providers, 26, 257, capture in current risk adjustment 259, 261, 264, 267, 277-278, 279, systems, 12, 70, 114, 131, 136, 147, 280, 283, 284, 285, 304, 307, 308 149, 213 measures of status, 49, 52, 100, 164 community context, 120, 182 165, 183, 366, 373, 477, 506, concept, 12, 69 520-521 dual eligibility and, 52, 371, 372 and occupation/employment, 49, 164, and health and health care, 12, 69, 71 373, 465, 506 and health literacy, 190 and patient experience, 118, 129, 131, income data, 504 133, 165 interventions by providers, 283 and quality and resource use, 145 qualification as Medicare beneficiary, and racial/ethnic disparities, 284 70, 109, 125-126, 127, 147, 149, recommendations, 10, 37, 52, 463, 468, 350, 372, 391 501, 538-539 value/stability as indicator, 71, 318 residential and community context, 63, wealth and, 162 100, 140, 182, 183, 185, 188, 383, Dual eligibility 513 and utilization of health care, 118, 161, and clinical processes of care, 372 164-165, 183, 185 data sources and collection, 52, 463, value/stability as indicator, 37, 52, 499-500, 516-517 68, 100, 261, 319, 326, 351, 352, defined, 126-127, 499-500 354, 356, 373, 389, 390, 392, 425, and disability, 52, 371-372 465, 479, 490, 495, 501, 514, 536, and health and health care, 52, 371, 372 538-539
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From page 553... ...
social and behavioral risk factors, 461, and clinical processes of care, 119, 178, 485, 497 220 social support, 62, 510 data sources and collection, 10, 58, 59, standardization of collection measures, 68-69, 324, 377, 467, 468, 485, 466-467, 485, 486-487, 506, 510, 488, 511-513, 528-529, 539 519, 521 definition and constructs, 6, 58, 319, urbanicity/rurality, 64, 463, 516 324, 377, 394, 468, 512 wealth, 54, 509, 523 and health and health care, 58, 113, Employment (see also Occupation) 119, 177-178, 377-379, 468 and clinical processes of care, 165-166 measures, 377-378, 395, 468, and community/neighborhood-level 512-513 socioeconomic position (SEP)
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From page 554... ...
, 53, 325, 387-388 54, 460, 490, 508-509, 523, 524 exclusion as indicator, 10, 12, 69, 389, Health care outcomes, defined, 33 400 Health care use, defined, 33 and health and outcomes of care, 121, Health equity 160, 190-191, 335, 388, 389, 495 accountability for, 17, 249, 264, interventions, 283, 388 268-271 language barriers and, 325, 387-388, accounting for social risk factors and, 401 3, 4, 5, 17, 18, 20, 103-104 measures, 388, 401 case study, 266-267 numeracy, 121, 190, 325, 388, 400-401
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From page 555... ...
, 15, 79, 92-96, 110, 128 and clinical processes of care, 118, 162, 129, 134, 139, 140, 144, 207, 219, 164, 184-185, 367 230, 411 and costs of health care, 118, 164, 351
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From page 556... ...
188, 230, 350-351, 367, 370, 383, income and, 161, 163, 164, 371, 465, 466, 504 390-391 and health equity, 23, 345, 419 providers disproportionately serving and housing, 48, 162, 279, 367, 504 socially at-risk populations and, 28 individual-level, 36, 48-49, 52, 53, 68, as proxy for socioeconomic position, 93, 126, 161, 162-163, 164, 172, 117, 161 182-183, 213, 357, 365, 367-369, and unintended consequences of 370, 371, 373-374, 390-391, 392, accounting for social risk factors, 28 425, 460, 464, 465, 469, 481, 488, 489, 498, 501, 504-505, 514, 521 inequality, 188 L insurance status as a proxy for, 118, 161, 163, 164, 371, 390-391 Language barriers/proficiency interventions for low-income patients, acculturation and, 58, 376, 392, 512, 279, 286, 290 526, 527 measures, 29, 36, 48, 49, 162-163, 166, Centers for Medicare & Medicaid 367, 465, 504 Services (CMS) Strategic Language and Medicare premiums and subsidies, Access Plan, 56, 502 126-127, 138, 213, 505 and clinical processes of care, 119, 173 and nutrition, 48 174, 175 and patient experience, 118, 131, 133, community context, 55, 62, 182, 260, 164, 181, 367 290, 383, 398, 465, 506, 538-539 and patient safety, 182-183 and costs of health care, 174 race and ethnicity and, 55, 118, 167, data sources and collection, 7, 10, 38, 172, 374 56-57, 100, 271, 319, 375, 458, recommendations, 463-464, 501, 459, 463-464, 468, 469, 481, 483, 538-539 484, 485, 502-503, 514, 517, 518 research needs, 464, 501 519, 526, 527, 538-539 residential and community context, 63, and health and health care, 56, 71, 119, 182-183, 184-185, 188, 191, 383, 167, 173-174, 175, 176, 375, 376, 465-466, 501, 505, 507-508 503 stratified public reporting, 93, 424 and health literacy, 325, 387-388, 401 and utilization of health services, 118, interpreter use and effects, 35-36, 71, 174, 175, 249, 264, 266, 267, 304 161, 162, 164, 182, 183, 184, 188, limited English proficiency, 32, 56, 62, 290, 367 119, 129, 131, 142, 146, 167, 173 value/stability as indicator, 49, 53, 93, 175, 232, 274, 290, 319, 339, 375, 94, 100, 355, 357, 367, 373, 389, 376, 392, 464, 478, 502, 503, 519 390-391, 392, 424-425, 457, 463 measures of, 57, 58, 375, 484, 501, 503 464, 479, 495, 498, 536
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From page 557... ...
509 Advantage/Part C, 93, 110, 116, 126, and utilization of health care, 120, 180, 127, 132-133, 137, 150, 212-213, 380 221, 233, 240, 289, 315, 327, 409, value/stability as indicator, 7, 60, 61, 410-411, 413, 418, 432 326, 354-355, 379, 380-381, 389, Current Beneficiary Survey, 61, 102, 396-397, 457, 465, 466, 479, 496, 186, 482-483, 509-510 504, 508, 521, 536, 539 deductibles and coinsurance, 127 Five-Star Quality Rating System, 137, 212, 221, 240, 327, 418 M Hospital Compare, 221, 233, 240, 241 Income Related Monthly Adjustment Marital/partnership status Amounts, 505 and clinical processes of care, 120, 179, overview of program, 125-127 379 Part A, 126, 127, 136, 137, 413 community of residence and, 60, 380 Part B, 126, 127, 136, 137, 413, 415, and costs of care, 120, 379 465, 505 data sources and collection, 60, 463- Part D, 93, 110, 116, 126, 132-133, 465, 501, 503-504, 520-521, 538, 137, 138, 150, 163, 173, 212, 213, 539 221, 233, 240, 315, 327, 409, 410 gender interaction, 60, 379 411, 413-414, 465, 505
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From page 558... ...
units and, 13, 14, 15, 16, 80-81, 83, accuracy of performance scores, 15, 35, 84, 89, 90, 91, 329, 423, 424-425 83, 84 payment adjustment, 30, 92, 111, 112, between-provider adjustments and, 14, 129, 136, 138, 141, 142, 145, 207, 81-83, 88, 89, 330, 436 209, 211-212, 325 n.2, 337, 352, between-provider differences, 81, 387 n.1, 414, 415, 423 426-427 performance measure score adjustment, bonus for low disparities, 15, 84, 86, 3, 12, 13, 14, 16, 30, 78-79, 81-83, 90, 110 n.1, 330, 432-433, 434 86-87, 88-89, 91, 92, 93-94, 95, categories of methods, 12-17, 329, 329, 330, 422, 423, 426-427, 436 421-422 437, 496 combining approaches, 2, 14, 15, 16, previous recommendations, 144-145 19-20, 78, 79, 84, 90, 93, 94, 95, prior conclusions, 537-538 99, 105, 330-331, 434-435, 436- for public reporting, 2, 14, 15, 16, 437, 537 19-20, 78, 79, 84, 90, 93, 94, 95, committee approach, 77-79, 328-329 99, 105, 112, 330-331, 434-435, confounders, 111, 143, 330, 331, 344- 436-437, 537 345, 349, 350, 423, 435, 445 quality measures for performance added cost considerations, 79, 331, 425, 427, for at-risk groups, 426-427 429, 431, 433 rationale for, 3-4, 13 current programs, 411-414 reporting unit characteristics and, direct adjustment of payment, 12, 13, 80, 81, 87, 89, 90, 329-330, 423, 14-15, 16, 78, 79, 83-84, 86-87, 424-425 88-89, 92, 94, 95, 142, 329, 330, restructuring payment incentive design, 422-423, 428-429, 434 12, 13, 15-16, 78, 79, 86-87, 90-92, downweight social risk factor-sensitive 94, 95-96, 430-433 measures, 330, 432-433, 434 risk adjustment of performance drivers of differences in quality by measures, 111-112, 141, 142-144, social risk factors, 420-421 423, 426-427 example, 436-437 sample size considerations, 81, 93, 353, 424, 426, 432
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From page 559... ...
, 377, 460, 490, 528 National Survey on Drug Use and Health, 377 O Nativity and clinical processes of care, 119, 176- Occupation (see also Employment) 177, 376 and clinical processes of care, 165-166 and costs of care, 176 data sources and collection, 54, 165 data sources and collection, 57-58, 100, 166, 185, 372-373 376, 395, 463, 469, 487, 499, 500, defined, 54, 117, 161, 165, 372 514, 516-517, 538 education and, 49, 164, 373, 465, 506 defined, 57, 175, 375, 394, 463, 500 and health and health care, 118, 161, and health and health care, 175, 176, 165, 185 376 and patient experience, 118, 166 measures, 57, 376, 463
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From page 560... ...
social relationships and, 120 social support and, 181 socioeconomic position and, 118 P Pay-for-performance, 24, 109, 125, 135, 136, 141, 315, 335, 410, 412, 418, Patient-centered care, 4, 18, 24, 31, 103, 455 n.1, 475 n.1 223, 224, 245, 247, 260, 262, 266, Payment (see Value-based payment in 275, 286, 287, 288-289, 290, 303, Medicare) 316, 338, 477, 535 Performance indicators used in value-based Patient experience payment community context and, 121 clinical processes of care, 3-4, 8-9, 33, dual eligibility and, 372 34-35, 50-51, 114, 115, 116, 118, educational attainment and, 118, 129, 119, 120, 121, 128, 132, 135, 138, 131, 133, 165 141, 147, 148, 149, 150, 160, 162, gender identity and, 119, 178 164, 165-166, 169-170, 173-174, health literacy and, 160 175, 176-177, 178, 179, 180, income and, 118, 131, 133, 164, 181, 181, 184-185, 186, 189, 190, 191, 367 208-209, 220, 241, 268, 281-282, language proficiency and, 119, 129, 322-323, 344, 367, 368-369, 372, 131, 133, 174-175, 176-177 374, 376, 379, 380, 381, 382, 383, marital/partnership status and, 120, 385, 388, 412 179, 379 costs of care, 8-9, 14, 17, 33, 34-35, Medicare quality measure examples, 50-51, 69, 79, 83, 102, 111, 114, 116, 150 115, 116, 118, 119, 120, 121, 130 nativity and, 119, 176-177, 376 132, 136, 138, 139, 141, 142, 147, occupation and, 118, 166 148, 149, 150, 160, 162, 163, 164, race and ethnicity and, 119, 167, 172- 168, 173, 174, 175, 179, 182, 183, 173, 374 189, 190, 191, 210, 211, 212, 213, social support and, 120, 181, 381 225, 260, 277, 280, 322-323, 330, Patient Protection and Affordable Care Act 331, 344, 367, 368-389, 374, 379, of 2010 (ACA)
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From page 561... ...
279, 290, 322-323, 325 n.2, 344, community health centers, 221, 233, 350, 365, 367, 368-369, 372, 373, 237, 239, 240, 276, 278, 306, 335 374, 379, 380, 381, 383, 385, 386, 336, 418, 486 387 n.1, 388 critical access hospitals, 27, 220-221, patient experience, 8-9, 33, 34-35, 50- 233, 237, 239, 335-336, 418, 486 51, 114, 115-116, 118, 119, 120, direct payments for quality 121, 128, 129, 131, 132, 133, 135, improvement, 18, 94, 105 138-139, 147, 148, 150, 160, 162, direct payments to incentivize 163, 164, 165, 166, 167, 168, 172- collaborations, 18, 105 173, 174-175, 176-177, 178, 179, electronic health records, 486-487 181, 187, 189, 190, 191, 208, 209, inpatient care, 27, 139-140, 221, 219, 238, 241, 260, 265, 268, 275, 237-239 280, 322-323, 344, 367, 368-369, interventions to improve care (see 372, 373, 374, 376, 379, 381, 385, Systems practices) 388, 411, 412, 483 minority-serving institutions, 27, 80, patient safety, 8-9, 33, 34-35, 50-51, 140, 220-221, 233, 237, 238-239, 114, 115, 116, 118, 119, 120, 128, 240, 244, 335, 336, 418 130, 132, 135, 137, 138, 147, 148, outcomes of care, 221 150, 160, 162-163, 166, 173, 181, and payment systems, 3, 14-15, 27, 80, 182-183, 186, 208, 209, 210, 238, 139-141 239, 322-323, 344, 368-369, 374, penalties, 27, 113, 140, 141, 219, 229 383, 411, 412, 432, 487 230, 336
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From page 562... ...
, 118, unintended consequences of the status 120, 167, 374 quo of value-based payment (VBP) and measurement of performance, 93 programs, 3-4, 14, 27-28, 83, 84, 94, 271, 318, 319, 326, 349, 355, 103, 105, 111-112, 139-140, 141, 374, 376, 389, 392, 393, 394, 457, 142, 229, 230, 242, 336, 418, 435 463-464, 477, 479, 495, 501, 538 and neighborhood environments, 62, 118, 167, 184, 191, 374 R and patient experience, 119, 167, 172 173, 374 Race and ethnicity and patient safety, 119, 173, 374 and access to care, 167-168 and performance of minority-serving acculturation and, 58, 376, 394-395, institutions, 27, 80, 140, 141, 220 512 221, 229, 230, 233, 237, 238-239, categorization issues, 55, 167, 374-375, 240, 244, 335, 336, 418 393 and quality of care, 55, 167-168, 239, 374 and clinical processes of care, 119, 169- recommendations, 10, 37, 56, 463-464, 170, 173, 191, 374 468, 501, 514, 538-539 comparability/standardization of data, self-identification and self-reporting, 38, 55, 56, 57, 118, 167, 271, 374, 393, 55, 167, 374, 457, 464, 481 481-482, 502 and social disadvantage, 54-55, 118, and costs of care, 119, 121, 173, 191- 166, 374, 392 192, 374 stability as indicator, 39, 56, 355, 374 375, 376, 392, 498
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From page 563... ...
, 33 and, 448 Rurality (see also Urbanicity/rurality) general considerations, 5-7, 10, 12, and access to health care.
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From page 564... ...
69, 324, 378, 467, 468, 485, 488, data sets, 488-489 511-513, 528-529, 539 Health and Retirement Study, 490 definition and constructs, 6, 58, 319, income data, 49, 465, 469, 504, 505, 324, 378, 394, 468, 512 520, 521 and health and health care, 10, 59, 119, nativity data, 57, 58, 463, 469, 500, 177-178, 378-379, 468 514, 516, 517 measures, 59, 378, 395, 468, 512-513 Numident, 57, 488, 500 performance of providers, 220, 229, race and ethnicity data, 514, 519 230, 237 range of individual-level data, 10, 38, recommendations, 467, 511-512, 539 459-460, 488-489 value/stability as indicator, 10, 59, 68, Social support 324, 326, 378-379, 394-395, 396, and access to services, 61-62, 510 402, 457, 479, 496, 513, 537 and clinical processes of care, 120, 181, Skilled nursing facility services, 126, 239, 381 282, 386, 414, 416, 417 community context, 383 Skilled Nursing Facility Value-Based data sources and collection, 62, 466, Purchasing, 110, 112-113, 138, 467, 508, 510, 524-525, 539 213-214, 327, 414
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From page 565... ...
275, 280 measurement issues, 29-30 performance of providers and quality rankings for providers, 30, disproportionately serving socially 143-144 at-risk populations, 220-222, Socioeconomic status, defined (see also 237-241 Socioeconomic position) , 33, 117 practices to improve care, 18-19, 222Statement of task, 4-5, 30-31, 32, 113-114 223, 242-244, 248-259, 288-289, interpreting, 145-149 535-536 Systems practices, 244 prior conclusions, 535-536 case studies, 102-103, 222, 223, 233, resource and sustainability 243-244, 245, 247, 262, 266, 272- considerations, 18, 225, 287, 273, 274, 277, 279, 282, 284, 286, 288-291 303, 304-308, 386 statement of task, 220, 231, 232 collaborative partnerships, 18, 26, 103, 105, 223, 225, 244, 245, 246, 247, 254-255, 261, 269, 273-274, T 275-280, 290-291, 303, 306-307, Transportation, 26, 27, 62, 66, 120, 181, 535 187, 254, 259, 271, 282, 283, 288, 290, 370, 381-382, 384, 398, 468, 506, 510, 513, 529
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From page 566... ...
categories, 188-189 and, 219, 229 and clinical processes of care, 121, 189, addressing, 141-142 385 avoiding patients with social risk and costs of health care, 121, 189, 385 factors, 1, 4, 5, 14, 15, 28, 29, 78, data sources and collection, 64, 100, 83-84, 88-91, 327, 348, 419, 435 463, 499, 501, 506, 516-517, 523, between-provider/between-plan 538 adjustments and, 14, 81-83, 88, 89, defined, 64, 385, 398, 463, 500 330 and health and health care, 188-189, categories, 5, 78 385, 507 direct adjustment of payments and, 15, and health care resources, 189 88-89, 95 measures and measurement issues, 64, disincentives to improve quality and 324, 385, 387, 399, 463, 500-501, efficiency, 5, 14, 15-16, 28, 29, 71, 507, 528 78, 83, 85, 88-91, 111, 142, 327, and neighborhood deprivation, 189, 336, 337, 346, 347, 419, 427, 435, 385, 506, 507, 523 476 and patient experience, 121, 189, 385 insurance coverage denial, 418 and payment adjustments for hospitals, minimizing/mitigating, 79, 84-92, 110- 209 112, 141-142, 337 provider versus patient, 64, 385, 500 monitoring data for, 2, 37-38, 85, 91, and quality of care, 209, 239, 385 102, 332, 438 recommendation, 463, 499, 538 negative symbolic value, 5, 16, 80-81, residential and community context, 88-91, 328, 419 64-65, 188-189, 326, 385, 389, obscuring health disparities, 5, 16, 28, 398-399 29, 78, 85, 88-91, 93, 111, 139, social environment, 188 141, 142, 328, 337, 347, 420, 476 urbanization, 121, 188-189 patient characteristics within reporting and utilization of health care, 121, 189, units and, 16, 81, 141-142 385 of performance measure score value/stability as indicator, 326, 385, adjustment, 14, 82, 88-89, 111-112, 389, 398-399, 457, 479, 496, 499, 139-140 538 reporting unit characteristics and, 81 U.S. Census Bureau data, 63, 64-65, 100, restructuring payment incentive design, 324, 325 n.2, 383, 385, 387, 398, 78, 90-91 460, 463, 466, 489, 501, 506, 507 standards of care, 80-81 508, 516, 517, 523 status quo of value-based payment U.S.
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From page 567... ...
, 135, 208-209, 241 172 committee process, 115, 117, 149-151 Utilization of health care services Comprehensive Primary Care Plus, 327, community composition and, 120 417 community context and, 121 current programs, 110, 127-139, education and, 118, 161, 164-165, 183, 411-414 185 data on social risk factors, 458, 482 health literacy and, 121, 190-191, 388 domains of performance indicators, 33 housing and, 186, 187, 290, 386 with downside risk, 110, 130-131, 136 income and, 118, 161, 162, 164, 182, 137, 211-212, 326, 412-413 183, 184, 188, 290, 367 End-Stage Renal Disease Quality language proficiency and, 119, 174, 176 Improvement Program, 110, living alone and, 120, 180, 380 130-131, 136-137, 211-212, 326, marital/partnership status and, 120, 412-413 179, 379 future directions, 139 Medicare quality measure examples, goals, 3, 24, 25, 77, 109, 414-415 116, 150 for health plans, 137-138, 212-213 nativity and, 176 Home Health Value-Based Purchasing, neighborhood deprivation and, 183- 110, 132-133, 138-139, 327, 414 184, 188 Hospital-Acquired Condition Payment occupation and, 118, 165, 185 Reduction program, 110, 128, 135, race and ethnicity and, 119, 121, 168- 208, 326, 411 169, 173, 191-192, 267, 350, 365, hospital inpatient care, 134-135, 374 207-209 social support and, 120, 180, 181, 279, Hospital Readmissions Reduction 381 Program, 15, 27, 30, 79, 92-96, urbanicity/rurality and, 121, 189, 385 110, 128-129, 134, 139, 140, 144, 207, 219, 230, 326, 411 Hospital Value-Based Purchasing V program, 95, 110, 128, 135, 140, 208-209, 326, 411-412 Value-based payment in Medicare (see incentive payments for participation in, also Medicare; Methods to account 415 for social risk factors; Unintended innovative models under testing, 327 consequences of accounting for Medicare Access and CHIP social risk factors) Reauthorization Act of 2015 for ambulatory care, 135-137, 209-212 (MACRA)
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From page 568... ...
568 ACCOUNTING FOR SOCIAL RISK FACTORS IN MEDICARE PAYMENT monitoring disparities, 80 with upside gainsharing and downside Next Generation Accountable Care risk, 110, 128-129, 135-136, 209 Organizations (ACOs) , 327, 415, 210, 326, 412-413 416-417 overview of programs, 115, 117, 207 patient safety measures, 116, 120, 128, W 132, 135, 137, 150, 208, 209, 411, 412 Wealth pay-for-performance, 24, 109, 125, data sources and collection, 53-54, 466, 135, 136, 141, 315, 335, 410, 412, 490, 496, 508-509, 522-523 418, 455 n.1, 475 n.1 disabilities and, 162, 371, 372 Physician Value-Based Modifier, 136, dual eligibility as proxy, 52, 53-54, 68, 210-211, 326, 412, 415 371, 372, 500, 509, 522 population-based payments, 287, 315, gender and, 53, 370 327, 409, 410, 434, 455 and health and health care, 53, 162, population health approach, 25 319, 370, 373, 466, 508 for post-acute care, 138-139 and health equity, 23, 345 and provider risk, 24-25, 125, 315, and housing, 370, 508 335, 455, 475 and income, 53, 54, 55, 118, 162, 167, and racial disparities, 141 183, 370, 374, 466, 508, 509, 522 readmission measures, 92, 132, 207, measures, 53, 370, 466, 508, 539 213-214, 414 race and ethnicity and, 53, 55, 167, reinsurance, 138, 213, 327, 413 370, 374 risk corridors, 110 n.1, 133, 137 n.4, recommendations, 466, 508, 539 138, 213, 327, 413-414 value/stability as indicator, 48, 53, 117, Skilled Nursing Facility Value-Based 161, 319, 326, 355, 370, 390-391, Purchasing, 110, 112-113, 138, 402, 457, 479, 495, 496, 498, 508, 213-214, 327, 414 537, 539 statement of task, 113-114, 115-116 threshold-based, 82-83 unintended consequences of status quo, 1, 2, 3-4, 28-29, 37-38, 78, 81, 82, 86, 88, 90, 95, 229, 327-328, 337, 346, 417- 420, 434-435, 438, 537
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Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.