Social Risk Factors
Committee on Accounting for Socioeconomic Status
in Medicare Payment Programs
Leslie Y. Kwan, Kathleen Stratton, and Donald M. Steinwachs, Editors
Board on Population Health and Public Health Practice
Board on Health Care Services
Health and Medicine Division
A Report of
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This activity was supported by Contract No. HHSP233201400020B from the U.S. 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: 978-0-309-44920-5
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Digital Object Identifier: 10.17226/23635
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for social risk factors in Medicare payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
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COMMITTEE ON ACCOUNTING FOR SOCIOECONOMIC STATUS IN MEDICARE PAYMENT PROGRAMS
DONALD M. STEINWACHS (Chair), Professor Emeritus, 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,1 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 and 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 Policy, Harvard T.H. Chan School of Public Health
ANTHONY SHIH, Executive Vice President, The New York Academy of Medicine
KATHLEEN STRATTON, Study Director
LESLIE Y. KWAN, Associate Program Officer
EMILY VOLLBRECHT, Senior Program Assistant (until May 2016)
1 Resigned in July 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
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 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:
MICHAEL CHERNEW, Harvard Medical School
KAREN COOK, Stanford University
JACK EBELER, Independent Consultant
LISA I. IEZZONI, Harvard Medical School
DAVID NERENZ, Henry Ford Health System
THOMAS H. RICE, University of California, Los Angeles, Fielding School of Public Health
JOSHUA SHARFSTEIN, Johns Hopkins Bloomberg School of Public Health
DOUGLAS O. STAIGER, Dartmouth College
STEPHEN B. THOMAS, University of Maryland
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 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.
The Health and Human Services Assistant Secretary for Planning and Evaluation presented the committee with quite a challenge. From a substantive standpoint, the committee was asked to present options for accounting for social risk factors in Medicare value-based payment (VBP) programs. This is a demanding intellectual endeavor, requiring the committee to engage in interdisciplinary thinking, dialogue, analysis, and authorship. From a process standpoint, preparing and releasing five consensus reports in 15 months required a relentless push to think about each piece of this complex problem somewhat in isolation. The crafting of the early reports was done with only a sense of where the entire series would go. Committees of the National Academies of Sciences, Engineering, and Medicine (the National Academies) often have many months to shape and reshape even the very foundation of a report. With this series, the committee finalized work in the hopes that as the rest of the reports developed, the prior efforts remained relevant. I think that the committee has shown in this fifth report that each of the four previous reports provides the foundation for each that followed. I hope the reports are useful to the government, researchers, and the many health care providers who care for socially at-risk populations, who deserve the best health care quality the American health care system can provide.
I would like to thank the National Academies offices that worked efficiently and seamlessly to accommodate the committee’s rigorous timeline. More importantly, I would like to thank the National Academies project staff for their diligence and commitment to excellence and timeliness. Sharyl Nass and Rose Marie Martinez, the directors of the Boards on Health Care
Services and Population Health and Public Health Practice, provided strategic advice and helpful commentary throughout the process. The committee and I are extremely grateful for the expert and speedy research support provided by Leslie Kwan. Finally, we acknowledge the steady hand and experience provided by Kathleen Stratton.
I would also like to thank my fellow committee members. It has been my honor and privilege to work with each and every one of them. Their congeniality, expertise, good humor, and willingness to respectfully question each other and themselves made my job as chair a joy.
Another special thanks goes to the health policy researchers and policy analysts across the country who served as peer reviewers for this series of reports. The timeline was always tight, and they consistently kept to the deadlines. The cogent comments provided helped clarify our thinking and improved the reports immensely. I would particularly like to thank those who reviewed more than one report and, in some cases, all five. That you volunteered so much of your time to participate in multiple reviews in support of the National Academies’ process is admirable, and we are grateful.
Donald M. Steinwachs, Chair
Committee on Accounting for Socioeconomic
Status in Medicare Payment Programs