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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Criteria, Factors, and Methods. Washington, DC: The National Academies Press. doi: 10.17226/23513.
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ACCOUNTING FOR
Social Risk Factors
IN
Medicare Payment

________________________

Criteria, Factors, and Methods

Committee on Accounting for Socioeconomic Status in Medicare Payment Programs

Board on Population Health and Public Health Practice

Board on Health Care Services

Health and Medicine Division

Images

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Washington, DC

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Criteria, Factors, and Methods. Washington, DC: The National Academies Press. doi: 10.17226/23513.
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This activity was supported by Contract No. HHSP233201400020B from the Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-44293-0
International Standard Book Number-10: 0-309-44293-1
Digital Object Identifier: 10.17226/23513

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for social risk factors in Medicare payment: Criteria, factors, and methods. Washington, DC: The National Academies Press. doi: 10.17226/23513.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Criteria, Factors, and Methods. Washington, DC: The National Academies Press. doi: 10.17226/23513.
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Image

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Ralph J. Cicerone is president.

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The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

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Learn more about the National Academies of Sciences, Engineering, and Medicine at www.national-academies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Criteria, Factors, and Methods. Washington, DC: The National Academies Press. doi: 10.17226/23513.
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Reports document the evidence-based consensus of an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and committee deliberations. Reports are peer reviewed and are approved by the National Academies of Sciences, Engineering, and Medicine.

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Criteria, Factors, and Methods. Washington, DC: The National Academies Press. doi: 10.17226/23513.
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COMMITTEE ON ACCOUNTING FOR SOCIOECONOMIC STATUS IN MEDICARE PAYMENT PROGRAMS

DONALD M. STEINWACHS (Chair), Professor, Johns Hopkins Bloomberg School of Public Health

JOHN Z. AYANIAN, Alice Hamilton Professor of Medicine, Director, Institute for Healthcare Policy and Innovation, University of Michigan

CHARLES BAUMGART, Senior Medical Director, xG Health Solutions

MELINDA BUNTIN, Professor and Chair, Department of Health Policy, Vanderbilt University School of Medicine

ANA V. DIEZ ROUX, Dean and Distinguished Professor of Epidemiology, Drexel University School of Public Health

MARC N. ELLIOTT, Senior Principal Researcher, RAND Corporation

JOSÉ J. ESCARCE, Professor of Medicine, David Geffen School of Medicine, University of California, Los Angeles

ROBERT FERRER, Dr. John M. Smith, Jr. Professor, Department of Family & Community Medicine, University of Texas Health Science Center at San Antonio

DARRELL J. GASKIN, William C. and Nancy F. Richardson Professor of Health Policy and Director, Johns Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health

MARK D. HAYWARD, Professor of Sociology, Centennial Commission Professor in the Liberal Arts, Faculty Research Associate, Population Research Center, The University of Texas at Austin

JAMES S. JACKSON, Daniel Katz Distinguished University Professor of Psychology, Research Professor, Institute for Social Research, University of Michigan

DANIEL POLSKY, Executive Director, Leonard Davis Institute of Health Economics, University of Pennsylvania

MEREDITH ROSENTHAL, Professor of Health Economics and Policy, Harvard T.H. Chan School of Public Health

ANTHONY SHIH, Executive Vice President, The New York Academy of Medicine

Study Staff

KATHLEEN STRATTON, Study Director

LESLIE Y. KWAN, Associate Program Officer

PATRICK ROSS, Research Assistant (from May 2016)

EMILY VOLLBRECHT, Senior Program Assistant (until May 2016)

ALEXIS WOJTOWICZ, Senior Program Assistant (from May 2016)

REBECCA MORGAN, Senior Research Librarian

DORIS ROMERO, Financial Associate

HOPE HARE, Administrative Assistant

ROSE MARIE MARTINEZ, Senior Board Director, Board on Population Health and Public Health Practice

SHARYL NASS, Board Director, Board on Health Care Services

National Academy of Medicine Greenwall Fellow in Bioethics

BRENDAN SALONER, Assistant Professor, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Criteria, Factors, and Methods. Washington, DC: The National Academies Press. doi: 10.17226/23513.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Criteria, Factors, and Methods. Washington, DC: The National Academies Press. doi: 10.17226/23513.
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Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

ARLENE S. ASH, University of Massachusetts Medical School

JACK EBELER, Independent Consultant

GEORGE ISHAM, HealthPartners

DANA MUKAMEL, University of California, Irvine

DAVID R. NERENZ, Henry Ford Health System

JOSHUA M. SHARFSTEIN, Johns Hopkins Bloomberg School of Public Health

STEPHEN B. THOMAS, University of Maryland School of Public Health

ALAN M. ZASLAVSKY, Harvard Medical School

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by GEORGES C. BENJAMIN, American Public Health Association, and CHARLES E. PHELPS, University of Rochester. They were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Criteria, Factors, and Methods. Washington, DC: The National Academies Press. doi: 10.17226/23513.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Criteria, Factors, and Methods. Washington, DC: The National Academies Press. doi: 10.17226/23513.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Criteria, Factors, and Methods. Washington, DC: The National Academies Press. doi: 10.17226/23513.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Criteria, Factors, and Methods. Washington, DC: The National Academies Press. doi: 10.17226/23513.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Criteria, Factors, and Methods. Washington, DC: The National Academies Press. doi: 10.17226/23513.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Criteria, Factors, and Methods. Washington, DC: The National Academies Press. doi: 10.17226/23513.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Criteria, Factors, and Methods. Washington, DC: The National Academies Press. doi: 10.17226/23513.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Criteria, Factors, and Methods. Washington, DC: The National Academies Press. doi: 10.17226/23513.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Criteria, Factors, and Methods. Washington, DC: The National Academies Press. doi: 10.17226/23513.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Criteria, Factors, and Methods. Washington, DC: The National Academies Press. doi: 10.17226/23513.
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Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Criteria, Factors, and Methods. Washington, DC: The National Academies Press. doi: 10.17226/23513.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Criteria, Factors, and Methods. Washington, DC: The National Academies Press. doi: 10.17226/23513.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Criteria, Factors, and Methods. Washington, DC: The National Academies Press. doi: 10.17226/23513.
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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: Criteria, Factors, and Methods is the third in a series of five 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 builds on the conceptual relationships and empirical associations between social risk factors and performance indicators used in value-based payment identified in the first report to provide guidance on which factors could be considered for Medicare accounting purposes, criteria to identify these factors, and methods to do so in ways that can improve care and promote greater health equity for socially at-risk patients.

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