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
THE NATIONAL ACADEMIES PRESS
Washington, DC
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
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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Copyright 2016 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
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.
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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
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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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Contents
Criteria for Selecting Social Risk Factors
Applying Criteria to Social Risk Factors and Health Literacy
Methods to Account for Social Risk Factors in Value-Based Payment Programs
Rationale for Accounting for Social Risk Factors in Quality Measurement and Payment
Criteria for Selecting Social Risk Factors
Guidance Regarding the Process for Using Selection Criteria
3 APPLYING CRITERIA TO SOCIAL RISK FACTORS AND HEALTH LITERACY
Race, Ethnicity, and Cultural Context
Residential and Community Context
4 METHODS TO ACCOUNT FOR SOCIAL RISK FACTORS IN MEDICARE VALUE-BASED PAYMENT
Incentive Design in Medicare Payment Programs
Potential Harms of the Status Quo Compared to Accounting for Social Risk Factors
Methods to Account for Social Risk Factors in Value-Based Payment Programs
