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Suggested Citation:"Index." 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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Index

A

Accountable care organizations (ACOs)

accounting for social risk factors, 514-515

Medicare Shared Savings Program, 110, 128-129, 135-136, 209-210, 326, 412-413, 415, 416

Next Generation, 327, 415, 416-417

provider risk, 24-25, 125, 335

reducing readmissions, 289, 291

safety-net, 278

unintended consequences, 219, 229

Acculturation

community context, 383

data sources and collection, 377, 395, 512, 526-527, 539

defined, 57, 375, 467, 512

duration in United States and, 57, 58, 375-376, 512

and health and health care, 57, 176, 319, 376, 383, 467-468, 511-512

language proxy for, 57, 58, 376, 392, 512, 526, 527

measures, 57, 58, 319, 375-376, 394, 512

nativity proxy for, 57, 175, 376, 394

race and ethnicity and, 58, 376, 394-395, 512

recommendation, 467, 511-512, 539

value/stability as indicator, 58, 319, 326, 376, 377, 402, 457, 479, 495, 537

Agency for Healthcare Research and Quality (AHRQ)

Patient Safety Indicator, 116, 120, 128, 135, 150, 208, 209

Alliance of Community Health Plans, 222, 233, 243, 303

Ambulatory care

End-Stage Renal Disease Quality Improvement Program, 110, 130-131, 136-137, 211-212, 326, 412-413

Medicare Shared Savings Program, 110, 128-129, 135-136, 209-210, 326, 412-413

Physician Value-Based Modifier, 136, 210-211, 326, 412, 415

race and ethnicity and, 172

value-based payment (VBP) programs, 135-137, 209-212

American Community Survey

area-level data, 10, 38, 49, 52, 57, 63, 65, 460, 465, 467

description, 489

education data, 52, 465, 506, 520, 521

housing data, 65, 460, 467, 511, 526

income data, 49, 460, 465, 505, 507, 520, 521

Suggested Citation:"Index." 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.
×

language data, 57, 503, 518

living alone data, 524

neighborhood deprivation indicators, 63, 460, 522

sample size limitations, 489, 507

urbanicity/rurality data, 516, 517

B

Behavioral Risk Factor Surveillance System (BRFSS), 68, 377, 513

Bundled payments, 24-25, 109, 137, 327, 416, 434

Bundled Payments for Care Improvement (BPCI) Initiative, 110 n.1, 127 n.1, 335, 415, 416

C

Centers for Disease Control and Prevention, 128, 132, 135, 137, 208, 209, 411, 412

Centers for Medicare & Medicaid Services (see also Medicare; Value-based payment in Medicare)

Accountable Health Communities model, 26, 231

Equity Plan for Improving Quality in Medicare, 59, 468, 512-513, 528

Hierarchical Condition Category (HCC) clinical risk adjustment model, 101, 132-133, 136, 213, 348, 445-449

Home Health Outcome Assessment Information Set, 61, 510

Innovation Center, 26

Office of Minority Health, 57, 503

Strategic Language Access Plan, 56, 502

Clinical processes of care

community composition and, 120

dual eligibility and, 372

education and, 165

gender identity and, 119, 178, 220

health literacy and, 121, 160, 191, 268, 281-282, 388

income and, 118, 162, 164, 184-185, 367

language proficiency and, 119, 173-174, 175

living alone and, 120, 180, 380

marital/partnership status and, 120, 179, 379

nativity and, 119, 176, 376

occupation and, 165-166

quality measures, 116, 128, 135, 208-209, 241

race and ethnicity and, 119, 169-170, 173, 191, 374

sexual orientation and, 119, 177-178, 220

social support and, 120, 181, 381

urbanicity/rurality and, 121, 189, 385

Clinical risk factor adjustments, 1, 3-4, 12, 28-29, 69, 70-71, 95, 102, 191, 337, 344-345, 437

Community context, defined, 260 (see also Cultural context; Residential and community context)

Community health centers, 221, 233, 237, 239, 240, 276, 278, 306, 335-336, 418, 486

federally qualified health centers, 239, 278, 279, 284

Community-informed care, 4, 18, 24, 31, 103, 223, 224, 244, 245, 260-261, 262, 266, 275, 286, 287, 288-289, 303, 316, 338, 477, 535

Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, 93, 128, 165, 172, 174, 348, 353, 445, 448, 482-483, 519, 520

Costs of care (see also Resource use, defined)

educational attainment and, 164

health literacy and, 121, 160, 190, 191, 388

income and, 118, 164, 351

language proficiency and, 174

marital/partnership status and, 120, 379

Medicare quality measure examples, 116, 150

nativity and, 176

race and ethnicity and, 119, 121, 173, 191-192, 374

urbanicity/rurality and, 121, 189, 385

Critical access hospitals, 27, 220-221, 233, 237, 239, 335-336, 418, 486

Cultural competency training, 264-265

Suggested Citation:"Index." 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.
×

Cultural context (see also Acculturation; Language barriers/proficiency; Nativity)

definition and constructs, 6

D

Data sources and collection issues (see also Electronic health record data)

acculturation, 377, 395, 512, 526-527, 539

accuracy considerations, 10, 37, 38, 39, 40, 48, 101, 353, 457-458, 461, 462, 496, 498, 526

alternative government sources, 7-8, 38, 459-460, 488-490 (see also American Community Survey; Social Security Administration)

approach to collecting data, 149-151, 469, 471, 514-530

area-level measures as proxies for individual-level constructs, 10, 38, 49, 52, 57, 62-63, 100, 120, 181-184, 383-384, 459, 460, 465, 488, 489, 503, 505, 506, 507, 520, 521

burden and cost of collection, 7, 10, 37, 38, 39, 54, 57, 62, 100, 101, 320, 352, 353, 360, 382, 386, 388, 401, 450, 457-458, 459, 460, 462, 463, 482, 484, 487, 496, 498, 500, 504, 509, 516, 517, 520, 522, 526

categories, 37

clinical usefulness, 10, 39, 40, 52, 56, 57, 60, 61, 62, 459, 460, 461, 462, 463, 464, 466, 467, 485, 496, 497, 498, 500, 502-503, 506, 510, 511, 516, 520, 522, 524, 526, 538

Centers for Medicare & Medicaid Services (CMS) administrative records, 7, 37, 55, 64, 458, 459, 463, 464, 482-484, 501, 502

Centers for Medicare & Medicaid Services (CMS) surveys, 7, 9, 37, 55, 56, 61, 93, 102, 128, 165, 172, 174, 186, 348, 353, 386, 445, 448, 458, 482-483, 509-510, 519, 520,

collection considerations, 37-39, 100-101, 460-469

committee process, 149-151, 457, 477, 479

dual eligibility, 52, 499-500

education, 10, 37, 49, 52, 100, 112, 458, 463-464, 468, 469, 483, 484, 505-506, 520-521

gender identity, 10, 58, 59, 68-69, 324, 377, 467, 468, 485, 488, 511-513, 528-529, 539

guiding principles for choosing, 39, 40, 52, 345-347, 461-462, 498, 500, 538

housing, 65, 386, 398, 458, 460, 467, 484, 489, 496, 508, 510-511, 526, 539

imputed data, 56, 57, 464, 469, 502, 503, 515, 518, 519

income, 48-49, 162-163, 367, 460, 465, 469, 481, 487, 488, 501, 504-505, 507, 514, 520-521, 523

language barriers, 7, 10, 38, 56-57, 100, 271, 319, 375, 458, 459, 463-464, 468, 469, 481, 483, 484, 485, 502-503, 514, 517, 518-519, 526, 527, 538-539

living alone, 61, 466, 508, 509-510, 524-525, 539

marital/partnership status, 60, 463-465, 501, 503-504, 520-521, 538, 539

national surveys (other than American Community Survey [ACS]), 489-490

nativity, 57, 58, 463, 469, 500, 514, 516, 517

neighborhood deprivation, 63, 387, 463-464, 465, 501, 506-507, 508, 522-523

neighborhood environments, 10, 38, 63, 513-514

occupation, 54, 165-166, 185, 372-373

prior conclusions, 538-540

privacy and security concerns, 38, 53, 320, 353, 360, 459, 460, 487, 488, 508

providers and insurance plans, 7, 37-38, 458-459, 484-487

race and ethnicity, 7, 10, 37, 38, 39, 55-56, 169, 266, 271, 374, 375, 457, 458, 463-464, 468, 469, 481-482, 483, 484, 485, 501, 502, 514, 515, 518-519, 538-539

recommendations, 37, 49, 461-469, 538-540

risk tiering tool, 273

Suggested Citation:"Index." 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.
×

sample size considerations, 446, 447, 448, 484, 488, 489, 490, 507, 528

self-identification and self-reporting, 38, 48, 53, 55, 56, 58, 129, 166, 167, 169, 175, 238, 367, 370, 374, 377, 380, 457, 464, 466, 469, 481, 502, 504, 508, 512, 515, 519

sexual orientation, 10, 59, 68-69, 324, 378, 467, 468, 485, 488, 511-513, 528-529, 539

Social Security Administration, 10, 38, 49, 57, 58, 459-460, 463, 465, 469, 488-490, 500, 504, 505, 514, 516, 517, 519, 520, 521

social support, 62, 466, 467, 508, 510, 524-525, 539

standardization issues, 10, 38, 49-50, 52, 55-56, 57, 59, 60, 61, 62, 100, 251, 271, 305, 374, 393, 457-462, 464-468, 481-486, 488, 489, 497, 499, 502, 503, 505, 506, 510, 513, 518-522, 524, 526, 528, 529

statement of task, 456-457, 476-477, 478

urbanicity/rurality, 64, 100, 463, 499, 501, 506, 516-517, 523, 538

wealth, 508-509

Disability

built environment and, 187

capture in current risk adjustment systems, 12, 70, 114, 131, 136, 147, 149, 213

community context, 120, 182

concept, 12, 69

dual eligibility and, 52, 371, 372

and health and health care, 12, 69, 71

and health literacy, 190

income data, 504

interventions by providers, 283

qualification as Medicare beneficiary, 70, 109, 125-126, 127, 147, 149, 350, 372, 391

value/stability as indicator, 71, 318

wealth and, 162

Dual eligibility

and clinical processes of care, 372

data sources and collection, 52, 463, 499-500, 516-517

defined, 126-127, 499-500

and disability, 52, 371-372

and health and health care, 52, 371, 372

as income proxy, 52, 68, 100, 117, 161, 371, 372, 390, 392, 500

and patient experience, 372

recommendation, 463, 499, 538

and utilization of health care, 163, 164, 273

value/stability as indicator, 48, 68, 100, 117, 319, 326, 371-372, 373-374, 389, 390, 457, 479, 495, 536

as wealth proxy, 52, 53-54, 68, 371, 372, 500, 509, 522

E

Education

and clinical processes of care, 165

and costs of care, 164

data sources and collection, 10, 37, 49, 52, 100, 112, 458, 463-464, 468, 469, 483, 484, 505-506, 520-521

and health and health care, 49, 118, 161, 164, 165, 183, 284, 373, 383, 391, 392, 465, 505-506

and health literacy, 12, 49, 69, 325, 387-388

and income, 48, 49, 118, 162, 164, 367, 373, 465, 504, 506

interventions by providers, 26, 257, 259, 261, 264, 267, 277-278, 279, 280, 283, 284, 285, 304, 307, 308

measures of status, 49, 52, 100, 164-165, 183, 366, 373, 477, 506, 520-521

and occupation/employment, 49, 164, 373, 465, 506

and patient experience, 118, 129, 131, 133, 165

and quality and resource use, 145

and racial/ethnic disparities, 284

recommendations, 10, 37, 52, 463, 468, 501, 538-539

residential and community context, 63, 100, 140, 182, 183, 185, 188, 383, 513

and utilization of health care, 118, 161, 164-165, 183, 185

value/stability as indicator, 37, 52, 68, 100, 261, 319, 326, 351, 352, 354, 356, 373, 389, 390, 392, 425, 465, 479, 490, 495, 501, 514, 536, 538-539

Suggested Citation:"Index." 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.
×

Electronic health record (EHR) data

adoption and interoperability extent, 459, 469, 484-485, 486-487, 515

barriers to collection, 486-487

burdens of collecting, 459, 463, 487

clinical utility, 497

comprehensive needs assessment and, 274

educational attainment, 49-50, 52, 458, 465, 484, 506

housing, 65, 458, 467, 484, 511, 527

language, 7, 38, 458, 484, 485, 518-519

living alone, 61, 466, 510, 525

meaningful use, 52, 56 n.6, 57, 377, 378, 415, 459, 485, 506

nativity, 57, 376, 463, 500

partnership status, 60, 464, 503, 521

privacy and security issues, 459

race and ethnicity, 7, 38, 55, 458, 464, 484, 485, 502, 518

rationale for using, 40, 353

recommendations, 462, 538

research needs, 54, 466, 509, 521

residential and community context, 64, 65, 458, 501, 511, 516, 522

sexual orientation and gender identity, 58, 68, 485, 513, 529

social and behavioral risk factors, 461, 485, 497

social support, 62, 510

standardization of collection measures, 466-467, 485, 486-487, 506, 510, 519, 521

urbanicity/rurality, 64, 463, 516

wealth, 54, 509, 523

Employment (see also Occupation)

and clinical processes of care, 165-166

and community/neighborhood-level socioeconomic position (SEP), 63, 140, 182, 185, 188, 383, 507

data sources and collection, 54, 165, 166, 372-373, 391, 465, 507

defined, 54, 165, 372, 390

education and, 49, 373, 465, 506

and health and health care outcomes, 161, 165, 372, 373, 465, 506

and patient experience, 166

and quality of care, 372-373

and utilization of health services, 165-166, 185

value/stability as indicator, 165, 365-366, 372-373, 390-391

of working aged, 212 n.1

End-stage renal disease (ESRD), 109, 114, 115, 125-126, 147, 149, 151, 318, 365

End-Stage Renal Disease Quality Incentive Program, 110, 130-131, 136-137, 211-212, 326, 412-413

F

Fee-for-service payment systems, 1, 3, 24, 25, 109, 125, 126, 136, 137, 212, 219, 315, 326, 335, 343, 410, 416, 475 n.1

Food sufficiency/insecurity, 3, 24, 163, 166, 270, 290, 357, 392

G

Gender (normative), 121, 147, 159, 177, 191, 220, 319, 335, 352, 355, 365, 370, 377, 378, 379, 394-395, 396, 448, 457, 477, 481, 495

defined, 119

Gender identity (nonconforming)

and clinical processes of care, 119, 178, 220

data sources and collection, 10, 58, 59, 68-69, 324, 377, 467, 468, 485, 488, 511-513, 528-529, 539

definition and constructs, 6, 58, 319, 324, 377, 394, 468, 512

and health and health care, 58, 113, 119, 177-178, 377-379, 468

measures, 377-378, 395, 468, 512-513

and patient experience, 119, 178

performance of providers, 220, 229, 230, 237

recommendations, 467, 511-512, 539

value/stability as indicator, 10, 59, 68, 324, 326, 379, 394-395, 396, 402, 457, 479, 496, 513, 537

Suggested Citation:"Index." 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.
×

H

Health and health care

acculturation and, 57, 176, 319, 376, 383, 467-468, 511-512

community composition and, 120

community context and, 121

dual eligibility and, 52, 371, 372

education and, 49, 118, 161, 164, 165, 183, 284, 373, 383, 391, 392, 465, 505-506

gender identity and, 58, 113, 119, 177-178, 377-379, 468

housing and, 3, 24, 65, 187, 188, 386, 398, 467, 511

income and, 48, 118, 161, 162-163, 164, 172, 182, 184, 188, 230, 350-351, 367, 370, 383, 465, 466, 504

language proficiency and, 56, 71, 119, 167, 173-174, 175, 176, 375, 376, 503

living alone and, 61, 120, 179-180, 380, 382

marital/partnership status and, 60, 120, 178-179, 324, 379, 382

Medicare quality measure examples, 116, 150

nativity and, 175, 176, 376

occupation and, 118, 161, 165, 185

race and ethnicity and, 55, 100, 113, 118, 119, 121, 142, 147, 159, 167, 168, 170-172, 184, 191-192, 335, 349, 350, 365, 374, 394, 495

sexual orientation and, 10, 59, 119, 177-178, 378-379, 468

social support and, 60, 120, 180-181, 273, 324, 381, 382, 383, 510

urbanicity/rurality and, 188-189, 385, 507

wealth and, 53, 162, 319, 370, 373, 466, 508

Health and Retirement Study (HRS), 53, 54, 460, 490, 508-509, 523, 524

Health care outcomes, defined, 33

Health care use, defined, 33

Health equity

accountability for, 17, 249, 264, 268-271

accounting for social risk factors and, 3, 4, 5, 17, 18, 20, 103-104

case study, 266-267

concept, 2-3, 23, 229 n.1

culture of equity, 249, 263, 264-271

designing interventions to reduce inequities, 17, 18, 24, 92, 265

health information technology and, 268, 273, 277

health system level, 2, 23

integration into strategic planning, 249, 262, 263, 265, 269

payment policies and, 24, 83, 249

population level, 2, 3, 23-24

provider collaboration with outside organizations to improve, 26-27, 102-104, 233, 244, 253-254, 261, 277, 278-280, 290-291

quality improvement, 3, 17, 18

redesigning care to promote, 249, 262, 263, 264, 265-269, 275, 276, 278, 417

research needs, 18

resource alignment and allocation, 249, 263-264, 278

workforce investments to promote, 249, 263, 264-265

Health information technology (HIT), 56 n.6, 268, 273, 277, 278, 281, 287, 417, 459, 485, 487 (see also Electronic health record data)

Health insurance plans (see Insurance coverage; Medicaid; Medicare; Value-based payment in Medicare)

Health literacy

and access to care, 160, 388

and clinical processes of care, 121, 160, 191, 268, 281-282, 388

and compensation of providers, 325, 354, 389

and cost of care, 121, 160, 190, 191, 388

defined, 69, 121, 325, 387, 400

educational attainment and, 12, 49, 69, 325, 387-388

exclusion as indicator, 10, 12, 69, 389, 400

and health and outcomes of care, 121, 160, 190-191, 335, 388, 389, 495

interventions, 283, 388

language barriers and, 325, 387-388, 401

measures, 388, 401

numeracy, 121, 190, 325, 388, 400-401

Suggested Citation:"Index." 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.
×

and patient experience, 121, 160, 191, 388

and patient safety, 160

and quality of care, 35, 160

rationale for inclusion in study, 32, 69, 112, 121, 142, 145, 146, 147, 190, 220, 231, 232, 237, 316, 318, 338, 339, 387-388, 478

and utilization of health care, 121, 190-191, 388

Health outcomes, defined, 33

Health Resources and Services Administration, 276, 279

Healthcare Effectiveness and Data Information Set (HEDIS), 93

Home health care, 126, 172, 281, 416, 483

Home Health Outcome Assessment Information Set, 61, 510

Home Health Prospective Payment Final Rule, 138, 414

Home Health Value-Based Purchasing, 110, 132-133, 138-139, 327, 414

Hospice care, 126, 282, 483

Hospital-Acquired Condition Payment Reduction program, 110, 128, 135, 208, 326, 411

Hospital Consumer Assessment of Healthcare Providers and Suppliers (HCAHPS) survey, 128, 208-209, 353

Hospital inpatient care

community benefit/charity care requirement, 26-27, 277

Hospital-Acquired Condition Payment Reduction program, 135, 208

Hospital Readmissions Reduction Program (HRRP), 15, 27, 30, 79, 92-96, 110, 128-129, 134, 139, 140, 144, 207, 219, 230, 326, 411

Hospital Value-Based Purchasing program, 95, 110, 128, 135, 140, 208-209, 326, 411-412

Medicare Part A, 126, 127, 136, 137, 413

value-based payment (VBP) programs, 134-135, 207-209

Veterans Affairs (VA) hospitals, 172-173, 177

Hospital Readmissions Reduction Program (HRRP), 15, 79, 92-96, 110, 128-129, 134, 139, 140, 144, 207, 219, 230, 411

Housing

accounting for, in payment systems, 326, 389-390, 398-399, 457, 479, 526, 536

data sources and collection, 65, 386, 398, 458, 460, 467, 484, 489, 496, 508, 510-511, 526, 539

health and health care, 3, 24, 65, 187, 188, 386, 398, 467, 511

health system interventions, 26, 27, 253-254, 261, 277, 278-280, 290-291

income and, 48, 162, 367, 504

measures of, 65, 324, 386, 387, 467, 510-511, 526, 539

recommendations, 65, 467, 510-511, 539

research needs, 100, 510-511, 539

residential built environment, 66, 120, 181, 187, 188, 384, 398-399, 506, 513

responsibility for improving, 355-356

and utilization of health services, 186, 187, 290, 386

wealth and, 370, 508

I

Identifying social risk factors

conceptual framework, 8-9, 33-34, 50-51, 147-149

definitions, 33

selection criteria, 5-6, 10, 12, 35-36

Immigrants/immigration (see Acculturation; Language barriers/proficiency; Nativity)

Improving Medicare Post-Acute Care Treatment (IMPACT) Act, 4, 12, 31, 69, 110, 112, 121, 127, 138, 144, 145, 147, 190, 220, 230-231, 316, 325, 338, 387-388, 410, 456-457, 476, 477

Income

area-level as proxy for individual-level, 10, 38, 49, 52, 57, 62-63, 100, 120, 181-184, 383-384, 459, 460, 465, 488, 489, 503, 505, 506, 507, 520, 521

and clinical processes of care, 118, 162, 164, 184-185, 367

and costs of health care, 118, 164, 351

Suggested Citation:"Index." 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.
×

data sources and collection, 48-49, 162-163, 367, 460, 465, 469, 481, 487, 488, 501, 504-505, 507, 514, 520-521, 523

disability and, 70, 149, 162, 365, 371, 504

dual eligibility proxy for, 52, 68, 100, 117, 161, 371, 372, 392, 500

education and, 49, 118, 162, 164, 367, 373, 465, 504, 506

and health and health care, 48, 118, 161, 162-163, 164, 172, 182, 184, 188, 230, 350-351, 367, 370, 383, 465, 466, 504

and health equity, 23, 345, 419

and housing, 48, 162, 279, 367, 504

individual-level, 36, 48-49, 52, 53, 68, 93, 126, 161, 162-163, 164, 172, 182-183, 213, 357, 365, 367-369, 370, 371, 373-374, 390-391, 392, 425, 460, 464, 465, 469, 481, 488, 489, 498, 501, 504-505, 514, 521

inequality, 188

insurance status as a proxy for, 118, 161, 163, 164, 371, 390-391

interventions for low-income patients, 279, 286, 290

measures, 29, 36, 48, 49, 162-163, 166, 367, 465, 504

and Medicare premiums and subsidies, 126-127, 138, 213, 505

and nutrition, 48

and patient experience, 118, 131, 133, 164, 181, 367

and patient safety, 182-183

race and ethnicity and, 55, 118, 167, 172, 374

recommendations, 463-464, 501, 538-539

research needs, 464, 501

residential and community context, 63, 182-183, 184-185, 188, 191, 383, 465-466, 501, 505, 507-508

stratified public reporting, 93, 424

and utilization of health services, 118, 161, 162, 164, 182, 183, 184, 188, 290, 367

value/stability as indicator, 49, 53, 93, 94, 100, 355, 357, 367, 373, 389, 390-391, 392, 424-425, 457, 463-464, 479, 495, 498, 536

wealth and, 53, 54, 55, 118, 162, 167, 183, 370, 374, 466, 508, 509, 522

Indicators of social risk factors (see also specific indicators)

marginal gains from including, 100-101, 460, 461, 496, 497, 539

relative importance, 10

Inpatient Prospective Payment System, 92, 134, 411

Insurance coverage (see also Dual eligibility; Health insurance plans; Medicare)

income and, 161, 163, 164, 371, 390-391

providers disproportionately serving socially at-risk populations and, 28

as proxy for socioeconomic position, 117, 161

and unintended consequences of accounting for social risk factors, 28

L

Language barriers/proficiency

acculturation and, 58, 376, 392, 512, 526, 527

Centers for Medicare & Medicaid Services (CMS) Strategic Language Access Plan, 56, 502

and clinical processes of care, 119, 173-174, 175

community context, 55, 62, 182, 260, 290, 383, 398, 465, 506, 538-539

and costs of health care, 174

data sources and collection, 7, 10, 38, 56-57, 100, 271, 319, 375, 458, 459, 463-464, 468, 469, 481, 483, 484, 485, 502-503, 514, 517, 518-519, 526, 527, 538-539

and health and health care, 56, 71, 119, 167, 173-174, 175, 176, 375, 376, 503

and health literacy, 325, 387-388, 401

interpreter use and effects, 35-36, 71, 174, 175, 249, 264, 266, 267, 304

limited English proficiency, 32, 56, 62, 119, 129, 131, 142, 146, 167, 173-175, 232, 274, 290, 319, 339, 375, 376, 392, 464, 478, 502, 503, 519

measures of, 57, 58, 375, 484, 501, 503

Suggested Citation:"Index." 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.
×

nativity and, 175, 176, 376, 517

and patient experience, 119, 129, 131, 133, 174-175, 176-177

preferred language, 35, 56, 57, 58, 100, 176-177, 266, 464, 481, 484, 485, 502, 503, 512, 518

race and ethnicity and, 55, 118, 167, 374, 394

recommendations, 10, 463-464, 468, 501, 514, 538-539

standards, 56-57, 100, 266, 271, 375, 464, 481-482, 484, 485, 502, 503, 518-519

and utilization of health services, 119, 174, 176

value/stability as indicator, 38, 129, 131, 133, 135, 142, 326, 355, 375, 376-377, 389, 392, 394, 457, 459, 461, 479, 495, 498, 536

Living alone

and clinical processes of care, 120, 180, 380

data sources and collection, 61, 466, 508, 509-510, 524-525, 539

and health and health care, 61, 120, 179-180, 380, 382

measures of status, 61, 179, 381, 382, 508, 509

recommendations, 466, 508, 539

regional context, 381, 397, 402

and social support, 61, 354, 380, 382, 509

and utilization of health care, 120, 180, 380

value/stability as indicator, 7, 60, 61, 326, 354-355, 379, 380-381, 389, 396-397, 457, 465, 466, 479, 496, 504, 508, 521, 536, 539

M

Marital/partnership status

and clinical processes of care, 120, 179, 379

community of residence and, 60, 380

and costs of care, 120, 379

data sources and collection, 60, 463-465, 501, 503-504, 520-521, 538, 539

gender interaction, 60, 379

and health and health care, 60, 120, 178-179, 324, 379, 382

measures of status, 60, 324, 380, 382, 503

and patient experience, 120, 179, 379

race and ethnicity and, 60, 380

recommendations, 463-464, 501, 538, 539

research needs, 60-61, 464, 465, 504, 538, 539

same-sex marriage, 60, 503-504

and social support, 60, 354, 379, 396, 464-465, 503, 504

socioeconomic position and, 60, 380

trends, 60, 379-380, 503-504

and utilization of health care, 120, 179, 379

value/stability as indicator, 7, 60-61, 324, 326, 354-355, 379, 380, 382, 389, 396-397, 461, 463-465, 479, 496, 498, 501, 521, 536, 538, 539

Medicaid patients, 52, 53-65, 131, 133, 136, 163-164, 212, 231, 237, 238, 239-240, 262, 273, 278, 279, 316, 336, 371, 482, 509, 522 (see also Dual eligibility)

Medically Complex Medical Home, 281, 282, 307, 308

Medicare (see also Centers for Medicare & Medicaid Services; Value-based payment in Medicare)

Advantage/Part C, 93, 110, 116, 126, 127, 132-133, 137, 150, 212-213, 221, 233, 240, 289, 315, 327, 409, 410-411, 413, 418, 432

Current Beneficiary Survey, 61, 102, 186, 482-483, 509-510

deductibles and coinsurance, 127

Five-Star Quality Rating System, 137, 212, 221, 240, 327, 418

Hospital Compare, 221, 233, 240, 241

Income Related Monthly Adjustment Amounts, 505

overview of program, 125-127

Part A, 126, 127, 136, 137, 413

Part B, 126, 127, 136, 137, 413, 415, 465, 505

Part D, 93, 110, 116, 126, 132-133, 137, 138, 150, 163, 173, 212, 213, 221, 233, 240, 315, 327, 409, 410-411, 413-414, 465, 505

Suggested Citation:"Index." 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.
×

premium costs, 126-127

quality measures, 116, 149

supplemental insurance (Medigap), 127

Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), 110, 127, 327, 410, 415

Medicare Improvements for Patients and Providers Act (MIPPA), 136-137, 211, 412

Medicare Payment Advisory Commission (MedPAC), 27, 112, 140, 144

Medicare Premier Hospital Quality Incentive Demonstration, 141

Medicare Shared Savings Program (MSSP), 110, 128-129, 135-136, 209-210, 326, 412-413

Merit-Based Incentive Payment System (MIPS), 131, 211, 415

Methods to account for social risk factors (see also Unintended consequences of accounting for social risk factors)

accuracy of performance scores, 15, 35, 83, 84

between-provider adjustments and, 14, 81-83, 88, 89, 330, 436

between-provider differences, 81, 426-427

bonus for low disparities, 15, 84, 86, 90, 110 n.1, 330, 432-433, 434

categories of methods, 12-17, 329, 421-422

combining approaches, 2, 14, 15, 16, 19-20, 78, 79, 84, 90, 93, 94, 95, 99, 105, 330-331, 434-435, 436-437, 537

committee approach, 77-79, 328-329

confounders, 111, 143, 330, 331, 344-345, 349, 350, 423, 435, 445

cost considerations, 79, 331, 425, 427, 429, 431, 433

current programs, 411-414

direct adjustment of payment, 12, 13, 14-15, 16, 78, 79, 83-84, 86-87, 88-89, 92, 94, 95, 142, 329, 330, 422-423, 428-429, 434

downweight social risk factor-sensitive measures, 330, 432-433, 434

drivers of differences in quality by social risk factors, 420-421

example, 436-437

formula unadjusted for measured performance, 83, 330, 428-429, 434

goals, 5, 16, 19-20, 77, 86-87, 91, 328, 329, 420-421

in Hospital Readmissions Reduction Program (HRRP) context, 93-96

improvement relative to own benchmark, 15, 84, 86, 329, 330, 422, 430-431

incentive design in Medicare payment programs, 410-417

innovative payment models, 415-417

mitigating unintended consequences, 84-92

monitoring effects of, 7, 14, 16, 37-38, 80, 85, 91, 251, 269-270, 271, 281, 305, 331-332, 352, 359, 380, 423, 424, 438-439, 446, 456, 476, 537-538

patient characteristics within reporting units and, 13, 14, 15, 16, 80-81, 83, 84, 89, 90, 91, 329, 423, 424-425

payment adjustment, 30, 92, 111, 112, 129, 136, 138, 141, 142, 145, 207, 209, 211-212, 325 n.2, 337, 352, 387 n.1, 414, 415, 423

performance measure score adjustment, 3, 12, 13, 14, 16, 30, 78-79, 81-83, 86-87, 88-89, 91, 92, 93-94, 95, 329, 330, 422, 423, 426-427, 436-437, 496

previous recommendations, 144-145

prior conclusions, 537-538

for public reporting, 2, 14, 15, 16, 19-20, 78, 79, 84, 90, 93, 94, 95, 99, 105, 112, 330-331, 434-435, 436-437, 537

quality measures for performance added for at-risk groups, 426-427

rationale for, 3-4, 13

reporting unit characteristics and, 80, 81, 87, 89, 90, 329-330, 423, 424-425

restructuring payment incentive design, 12, 13, 15-16, 78, 79, 86-87, 90-92, 94, 95-96, 430-433

risk adjustment of performance measures, 111-112, 141, 142-144, 423, 426-427

sample size considerations, 81, 93, 353, 424, 426, 432

Suggested Citation:"Index." 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.
×

stratification of benchmarks used for payment, 83, 428-429

stratified public reporting, 12, 13-14, 15, 16, 78-81, 83, 84, 86-89, 91, 92, 93, 94, 95, 271, 274-275, 423, 424-425, 436-437

within-provider differences, 14, 16, 81-82, 83, 88, 89, 90, 94, 330, 423, 426-427, 435, 436, 437

Minority-serving institutions, 27, 80, 140, 220-221, 233, 237, 238-239, 240, 244, 335, 336, 418

black-serving institutions, 238

Monitoring disparities, 7, 14, 16, 37-38, 80, 85, 91, 251, 269-270, 271, 281, 305, 331-332, 352, 359, 380, 423, 424, 438-439, 446, 456, 476, 537-538

N

National Health and Aging Trends Study (NHATS), 460, 490

National Health and Nutrition Examination Survey (NHANES), 68, 460, 488, 490, 513, 528

National Health Interview Survey (NHIS), 68, 377, 460, 490, 513, 528

National Healthcare Safety Network (NHSN), 128, 132, 135, 137, 208, 209, 411, 412

National Institute on Aging, 490

National Quality Forum (NQF), 36, 92, 112, 132, 144, 207, 213-214, 317-318, 348, 445, 449-450

National Survey of Family Growth (NSFG), 377, 460, 490, 528

National Survey on Drug Use and Health, 377

Nativity

and clinical processes of care, 119, 176-177, 376

and costs of care, 176

data sources and collection, 57-58, 100, 376, 395, 463, 469, 487, 499, 500, 514, 516-517, 538

defined, 57, 175, 375, 394, 463, 500

and health and health care, 175, 176, 376

measures, 57, 376, 463

and patient experience, 119, 176-177, 376

proxy for acculturation, 57, 376

race and ethnicity and, 118, 167, 374, 376, 394-395

recommendation, 463, 499, 538

and utilization of health services, 176

value/stability as indicator, 319, 326, 355, 376, 389, 394, 457, 461, 463, 479, 495, 498, 500, 536

Neighborhood deprivation/disadvantage

and community compositional characteristics, 62-63, 182, 324, 383, 387, 398, 465, 506

data sources and collection, 63, 387, 463-464, 465, 501, 506-507, 508, 522-523

and health care resources, 140, 188, 507

and hospital performance, 140

measurement of, 62-63, 182, 324, 465-466, 506, 507, 508, 523

proxy for individual- and area-level constructs, 63, 324, 387, 402, 464, 465, 506

recommendation, 63, 463-464, 501, 507-508, 538-539

research suggestion, 63, 100, 464, 466, 508

urban versus rural, 507-508, 523

and utilization of health care, 183-184, 188

value/stability as indicator, 326, 383, 387, 389, 457, 479, 496, 501, 507-508, 536, 538-539

Nursing Home Value-Based Purchasing Demonstration, 127 n.1

O

Occupation (see also Employment)

and clinical processes of care, 165-166

data sources and collection, 54, 165-166, 185, 372-373

defined, 54, 117, 161, 165, 372

education and, 49, 164, 373, 465, 506

and health and health care, 118, 161, 165, 185

and patient experience, 118, 166

Suggested Citation:"Index." 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.
×

and utilization of health services, 118, 165, 185

value/stability as indicator, 54, 319, 350, 355, 372-373, 374, 390-391, 392

Office of Management and Budget (OMB), 55, 56, 375, 393, 464, 484, 502, 518

Office of Personnel Management, 49, 505

Office of the National Coordinator for Health Information Technology (ONC), 55-56, 68, 378, 458-459, 468, 484-485, 486, 510

Outpatient care (see Ambulatory care)

P

Patient-centered care, 4, 18, 24, 31, 103, 223, 224, 245, 247, 260, 262, 266, 275, 286, 287, 288-289, 290, 303, 316, 338, 477, 535

Patient experience

community context and, 121

dual eligibility and, 372

educational attainment and, 118, 129, 131, 133, 165

gender identity and, 119, 178

health literacy and, 160

income and, 118, 131, 133, 164, 181, 367

language proficiency and, 119, 129, 131, 133, 174-175, 176-177

marital/partnership status and, 120, 179, 379

Medicare quality measure examples, 116, 150

nativity and, 119, 176-177, 376

occupation and, 118, 166

race and ethnicity and, 119, 167, 172-173, 374

social support and, 120, 181, 381

Patient Protection and Affordable Care Act of 2010 (ACA), 26, 110, 125, 127, 135, 136, 199, 219, 225, 274, 279, 315, 335, 410, 412-413, 445

Patient safety

Agency for Healthcare Research and Quality (AHRQ) indicators, 116, 120, 128, 135, 150, 208, 209

community composition and, 120

health literacy and, 160

income and, 182-183

Medicare quality measure examples, 116, 150

National Healthcare Safety Network indicators, 128, 132, 135, 137, 208, 209, 411, 412

race and ethnicity and, 119, 173, 374

social relationships and, 120

social support and, 181

socioeconomic position and, 118

Pay-for-performance, 24, 109, 125, 135, 136, 141, 315, 335, 410, 412, 418, 455 n.1, 475 n.1

Payment (see Value-based payment in Medicare)

Performance indicators used in value-based payment

clinical processes of care, 3-4, 8-9, 33, 34-35, 50-51, 114, 115, 116, 118, 119, 120, 121, 128, 132, 135, 138, 141, 147, 148, 149, 150, 160, 162, 164, 165-166, 169-170, 173-174, 175, 176-177, 178, 179, 180, 181, 184-185, 186, 189, 190, 191, 208-209, 220, 241, 268, 281-282, 322-323, 344, 367, 368-369, 372, 374, 376, 379, 380, 381, 382, 383, 385, 388, 412

costs of care, 8-9, 14, 17, 33, 34-35, 50-51, 69, 79, 83, 102, 111, 114, 115, 116, 118, 119, 120, 121, 130-132, 136, 138, 139, 141, 142, 147, 148, 149, 150, 160, 162, 163, 164, 168, 173, 174, 175, 179, 182, 183, 189, 190, 191, 210, 211, 212, 213, 225, 260, 277, 280, 322-323, 330, 331, 344, 367, 368-389, 374, 379, 385, 388, 412, 413, 418, 424-433, 438, 469, 514

Suggested Citation:"Index." 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.
×

health care outcomes, 3, 8-9, 10, 24, 33, 34-35, 36, 48, 49, 50-51, 52, 53, 55, 56, 57, 58, 59, 60, 61, 65, 69, 71, 100, 102, 111, 113, 114, 115, 116, 118, 119, 120, 121, 142, 147, 148, 150, 159, 160, 161, 162-163, 164, 165, 167, 168, 170-172, 173-174, 175, 176, 177-181, 182, 183, 184, 187, 188, 189, 190-192, 230, 273, 284, 318, 319, 320, 322-323, 324, 335, 344, 345, 348, 349-353, 360, 365, 367, 368-369, 370, 371, 372, 373, 374, 375, 376, 377-379, 380, 381, 382, 383, 384, 385, 386, 387, 388, 389, 390, 391, 392, 394, 396, 398, 400, 449, 465, 466, 467-468, 495, 503, 504, 505-506, 507, 508, 510, 511-512, 536

health care use and utilization, 8-9, 33, 34-35, 50-51, 69, 102, 114, 115, 116, 118, 119, 120, 121, 147, 148, 149, 150, 161, 162, 163, 164-165, 166, 168-169, 173, 174, 175, 176, 179, 180, 181, 182, 183-184, 185, 186, 187, 188, 189, 190-192, 267, 279, 290, 322-323, 325 n.2, 344, 350, 365, 367, 368-369, 372, 373, 374, 379, 380, 381, 383, 385, 386, 387 n.1, 388

patient experience, 8-9, 33, 34-35, 50-51, 114, 115-116, 118, 119, 120, 121, 128, 129, 131, 132, 133, 135, 138-139, 147, 148, 150, 160, 162, 163, 164, 165, 166, 167, 168, 172-173, 174-175, 176-177, 178, 179, 181, 187, 189, 190, 191, 208, 209, 219, 238, 241, 260, 265, 268, 275, 280, 322-323, 344, 367, 368-369, 372, 373, 374, 376, 379, 381, 385, 388, 411, 412, 483

patient safety, 8-9, 33, 34-35, 50-51, 114, 115, 116, 118, 119, 120, 128, 130, 132, 135, 137, 138, 147, 148, 150, 160, 162-163, 166, 173, 181, 182-183, 186, 208, 209, 210, 238, 239, 322-323, 344, 368-369, 374, 383, 411, 412, 432, 487

resource use, 8-9, 13, 14, 32, 33, 34-35, 48, 50-51, 79, 83, 112, 113-114, 115, 116, 118, 144-145, 146, 147, 148, 149, 150, 230-231, 232, 322-323, 325 n.2, 331, 339, 344, 365, 366, 368-369, 387 n.1, 415, 438, 478, 537

Physician Quality Reporting System, 136, 211, 412, 415

Physician Value-Based Modifier, 130-131, 136, 210-211, 326, 412, 415

Population health, defined, 25, 268

Post-acute care

home health, 110, 132-133, 138-139, 327, 414

skilled nursing facilities, 110, 112-113, 138, 213-214, 327, 414

value-based payment (VBP) programs, 138-139, 213-214

Providers disproportionately serving socially at-risk populations

ambulatory care, 27, 140, 221, 239-240, 336

best practices, 222-223, 244 (see also Systems practices)

community health centers, 221, 233, 237, 239, 240, 276, 278, 306, 335-336, 418, 486

critical access hospitals, 27, 220-221, 233, 237, 239, 335-336, 418, 486

direct payments for quality improvement, 18, 94, 105

direct payments to incentivize collaborations, 18, 105

electronic health records, 486-487

inpatient care, 27, 139-140, 221, 237-239

interventions to improve care (see Systems practices)

minority-serving institutions, 27, 80, 140, 220-221, 233, 237, 238-239, 240, 244, 335, 336, 418

outcomes of care, 221

and payment systems, 3, 14-15, 27, 80, 139-141

penalties, 27, 113, 140, 141, 219, 229-230, 336

Suggested Citation:"Index." 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.
×

performance measure score adjustment, 81, 82, 83, 94, 111-112

performance/quality variation, 3, 27, 82, 85, 103, 140, 141, 219, 220-222, 229, 237-241, 336

publicly reported performance data, 221, 240-241

restructuring payment incentive design, 94

revenues/resources under quality incentive schemes, 27-28, 83, 84, 103, 105, 112, 139-140, 141, 230, 242, 336, 418

safety-net providers, 1, 18, 27, 30, 80, 81, 87, 89, 94, 105, 140, 209, 219, 220-221, 225, 230, 233, 237, 238, 239, 263, 265, 266, 270, 272, 278, 287, 329, 335, 336, 418, 424, 428, 486

status quo under current value-based payment (VBP) programs, and, 28-29, 82

stratification by reporting unit characteristics, 60, 80

uninsured patient care, 28, 52, 163, 237, 238, 239, 273, 276, 286, 316, 336, 371

unintended consequences of the status quo of value-based payment (VBP) programs, 3-4, 14, 27-28, 83, 84, 103, 105, 111-112, 139-140, 141, 142, 229, 230, 242, 336, 418, 435

R

Race and ethnicity

and access to care, 167-168

acculturation and, 58, 376, 394-395, 512

categorization issues, 55, 167, 374-375, 393

and clinical processes of care, 119, 169-170, 173, 191, 374

comparability/standardization of data, 55, 56, 57, 118, 167, 271, 374, 393, 481-482, 502 and costs of care, 119, 121, 173, 191-192, 374

data sources and collection, 7, 10, 37, 38, 39, 55-56, 266, 271, 375, 457, 458, 463-464, 468, 469, 481-482, 483, 484, 485, 501, 502, 514, 515, 518-519, 538-539

definition and constructs, 6, 118, 374, 464, 501-502

and disability benefits, 70

and discrimination, 118, 166-167, 374

and health and health care, 55, 100, 113, 118, 119, 121, 142, 147, 159, 167, 168, 170-172, 184, 191-192, 220, 335, 349, 350, 365, 374, 394, 495

and health care equity, 23, 119, 167-168, 262, 266, 345, 346

and immigration status, 118, 167, 374, 376, 394-395

interventions to reduce disparities, 263, 264, 265, 267, 268, 269, 270, 276, 278, 282-283, 284, 285

and language proficiency, 55, 118, 167, 394

and marital or partnership status, 60, 380

and measurement error in socioeconomic position (SEP), 118, 120, 167, 374

and measurement of performance, 93-94, 271, 318, 319, 326, 349, 355, 374, 376, 389, 392, 393, 394, 457, 463-464, 477, 479, 495, 501, 538

and neighborhood environments, 62, 118, 167, 184, 191, 374

and patient experience, 119, 167, 172-173, 374

and patient safety, 119, 173, 374

and performance of minority-serving institutions, 27, 80, 140, 141, 220-221, 229, 230, 233, 237, 238-239, 240, 244, 335, 336, 418

and quality of care, 55, 167-168, 239, 374

recommendations, 10, 37, 56, 463-464, 468, 501, 514, 538-539

self-identification and self-reporting, 38, 55, 167, 374, 457, 464, 481

and social disadvantage, 54-55, 118, 166, 374, 392

stability as indicator, 39, 56, 355, 374-375, 376, 392, 498

Suggested Citation:"Index." 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.
×

and utilization of health care, 119, 121, 168-169, 173, 191-192, 242, 267, 350, 365, 374

Railroad Retirement Board, 49, 126, 505

Residential and community context (see also Neighborhood deprivation/disadvantage)

built/physical environment, 7, 62, 120, 187-188

community socioeconomic composition, 7, 62, 63, 120, 182-186, 383-384, 398-399

composite measures, 183-184, 185-186

contextual community effects, 120-121, 186-189

data sources and collection, 10, 38, 63, 513-514

defined, 120, 181-182

disabilities and, 120

educational attainment of area/neighborhood, 63, 183, 185

environmental measures, 62-66, 384-386, 398-399, 513-514

health care resources, 187-188

housing, 63, 65, 66, 120, 181, 187, 188, 384, 398-399, 506, 513

income of area/neighborhood, 63, 182-183, 184-185, 188

measure of group-level effects, 62, 184-186

occupations of area, 63, 185

proxy for individual-level effects, 62-63, 182-184

racial/ethnic minority residents, 62, 63, 118, 120, 167, 184, 185, 191, 374

research suggestion, 63

social environment, 7, 62, 120, 188-189

transportation, 26, 27, 62, 66, 120, 181, 187, 254, 259, 271, 282, 283, 288, 290, 370, 381-382, 384, 398, 468, 506, 510, 513, 529

urbanicity/rurality, 64-65, 188-189, 326, 385, 389, 398-399

value/stability as indicator, 10, 33, 62-63

Resource use, defined (see also Costs of care), 33

Rurality (see also Urbanicity/rurality)

and access to health care. 27, 64, 189, 385, 507

and clinical processes of care, 189

critical access hospitals, 27, 220-221, 233, 237, 239, 335-336, 418, 486

data sources and collection, 63, 144, 463, 466, 501, 508, 523

defined, 64

and health and health care outcomes, 239, 507

interventions to improve care, 284-285

language issues, 189

measures and measurement issues, 64, 385, 500-501, 507, 508

and neighborhood deprivation, 63, 466, 507, 508, 523

and payment adjustments for facilities, 211

provider versus patient, 64, 385, 500

recommendation, 466

and resource use, 112

and utilization of health care, 189

S

Safety-net providers, 1, 18, 27, 30, 80, 81, 87, 89, 94, 105, 140, 209, 219, 220-221, 225, 230, 233, 237, 238, 239, 263, 265, 266, 270, 272, 278, 287, 329, 335, 336, 418, 424, 428, 486

Selection criteria for social risk factors (see also Gender; Health literacy; Indicators of social risk factors; Methods to account for social risk factors; Race and ethnicity; Residential and community context; Social relationships; Socioeconomic position)

application to social risk factors and health literacy, 316-317, 318-326, 358-359, 365-402

Centers for Medicare & Medicaid Services (CMS)-Hierarchical Condition Category (HCC) model criteria and, 445-447

committee process, 338, 340, 347-348

Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey case-mix adjustment criteria and, 448

general considerations, 5-7, 10, 12, 317-318

guiding principles, 317-318, 345-347

Suggested Citation:"Index." 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.
×

manipulation- or gaming-resistant, 6, 36, 48, 318, 319, 321, 324, 348, 353, 356-358, 361, 366, 367, 372, 373, 374, 375, 376, 377, 380, 381, 382, 384, 385, 386, 388, 389, 390, 392, 394, 396, 398, 400, 450, 536

National Quality Forum criteria guidelines and, 449-450

outcome of interest, 36, 59, 318, 320, 344, 345, 348, 349-353, 360, 367, 375, 376, 378, 380, 381, 382, 384, 385, 387, 389, 390, 392, 394, 396, 398, 400, 449, 536

overarching considerations, 35-36, 318, 320-321, 348, 536

preceding care delivery and not modifiable by provider, 5-6, 36, 48, 318, 319, 321, 324, 348, 353-356, 361, 366, 367, 373, 374, 375, 376, 380, 381, 382, 384, 385, 387, 389, 390, 392, 394, 396, 398, 400, 536

prior conclusions, 536-537

statement of task, 316-317, 338, 339

U.S. Department of Health and Human Services (HHS)-Hierarchical Condition Category (HCC) risk adjustment model criteria and, 448-449

Sexual orientation

and clinical processes of care, 119, 178, 220

data sources and collection, 10, 59, 68-69, 324, 378, 467, 468, 485, 488, 511-513, 528-529, 539

definition and constructs, 6, 58, 319, 324, 378, 394, 468, 512

and health and health care, 10, 59, 119, 177-178, 378-379, 468

measures, 59, 378, 395, 468, 512-513

performance of providers, 220, 229, 230, 237

recommendations, 467, 511-512, 539

value/stability as indicator, 10, 59, 68, 324, 326, 378-379, 394-395, 396, 402, 457, 479, 496, 513, 537

Skilled nursing facility services, 126, 239, 282, 386, 414, 416, 417

Skilled Nursing Facility Value-Based Purchasing, 110, 112-113, 138, 213-214, 327, 414

Social relationships

constructs (see Living alone; Marital/partnership status; Social support)

and health and health care, 6-7, 59-60, 119-120

Social risk factors (see also Gender; Health literacy; Indicators; Methods to account for social risk factors; Race and ethnicity; Residential and community context; Selection criteria for social risk factors; Social relationships; Socioeconomic position)

conceptual framework, 5-7, 8-9, 50-51, 159-160, 318, 322-323, 338, 340

as confounders, 111, 143, 330, 331, 344-345, 349, 350, 423, 435, 445

definitions and literature search, 160-191

domains, 33, 159

implementation considerations, 402

influence, defined, 117

interventions to address social risk factors, 26-27, 102-104, 233, 244, 253-254, 261, 277, 278-280, 290-291

pathways of influence, 159-160

prior conclusions and recommendations, 144-145, 536-537

rationale for accounting for, 343-345

Social Security Administration (SSA)

data sets, 488-489

Health and Retirement Study, 490

income data, 49, 465, 469, 504, 505, 520, 521

nativity data, 57, 58, 463, 469, 500, 514, 516, 517

Numident, 57, 488, 500

race and ethnicity data, 514, 519

range of individual-level data, 10, 38, 459-460, 488-489

Social support

and access to services, 61-62, 510

and clinical processes of care, 120, 181, 381

community context, 383

data sources and collection, 62, 466, 467, 508, 510, 524-525, 539

Suggested Citation:"Index." 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.
×

emotional and instrumental components, 61-62, 180, 324, 379, 381-382, 466-467, 510

and health and health care, 60, 120, 180-181, 273, 324, 381, 382, 383, 510

health system interventions, 273, 381-382

living alone and, 61, 354, 380, 382, 509

marital/partnership status and, 60, 354, 379, 396, 464-465, 503, 504

measures of, 62, 181, 273, 324, 382, 397, 402, 464-465, 466, 508, 510, 539

and patient experience, 120, 181, 381

and patient safety, 181

recommendations, 466, 508, 539

and utilization of health care, 120, 180, 181, 279, 381

value/stability as indicator, 39, 61, 62, 178, 273, 324, 326, 354-355, 381-382, 396-397, 402, 457, 467, 479, 496, 508, 537

Socioeconomic position (SEP)

data sources, 161-166

defined, 6, 48, 117, 161

indicators/measures, 48-54, 117, 161-166 (see also Dual eligibility; Education; Food sufficiency/insecurity; Income; Insurance coverage; Occupation; Wealth)

measurement issues, 29-30

and quality rankings for providers, 30, 143-144

Socioeconomic status, defined (see also Socioeconomic position), 33, 117

Statement of task, 4-5, 30-31, 32, 113-114

interpreting, 145-149

Systems practices, 244

case studies, 102-103, 222, 223, 233, 243-244, 245, 247, 262, 266, 272-273, 274, 277, 279, 282, 284, 286, 303, 304-308, 386

collaborative partnerships, 18, 26, 103, 105, 223, 225, 244, 245, 246, 247, 254-255, 261, 269, 273-274, 275-280, 290-291, 303, 306-307, 535

commitment to health equity, 2, 23, 103, 223, 224, 225, 245, 246, 248-249, 263-271, 277, 288-289, 303, 304, 345

committee process and approach, 102-103, 231-233

comprehensive needs assessment, 223, 225, 245, 246, 252-253, 268, 272-275, 288-289, 303, 305-306, 535

context for this report, 225-226, 291-292

continuity of care, 224, 225, 245, 256-257, 269, 280-281, 282, 290-291, 303, 307-308, 535

data and measurement, 223, 245, 250-251, 268, 271-272, 273, 288-289, 303, 305-306, 535

engaging patients in their care, 103, 224, 245, 247, 252, 256, 258-259, 266, 269, 280, 281-285, 286, 303, 308-309, 536

evidence base for practices, 260-285

identifying systems practices, 223-225, 233, 244-259

interventions to address social risk factors, 26-27, 102-104, 233, 244, 253-254, 261, 277, 278-280, 290-291

and patient experiences of care, 238, 241, 260, 264, 265, 266, 267, 268, 275, 280

performance of providers disproportionately serving socially at-risk populations, 220-222, 237-241

practices to improve care, 18-19, 222-223, 242-244, 248-259, 288-289, 535-536

prior conclusions, 535-536

resource and sustainability considerations, 18, 225, 287, 288-291

statement of task, 220, 231, 232

T

Transportation, 26, 27, 62, 66, 120, 181, 187, 254, 259, 271, 282, 283, 288, 290, 370, 381-382, 384, 398, 468, 506, 510, 513, 529

Suggested Citation:"Index." 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.
×

U

Uninsured persons, 52, 163, 237, 238, 239, 273, 276, 286, 316, 336, 371, 355-356

Unintended consequences of accounting for social risk factors

access to care, 28, 435

accountable care organizations (ACOs) and, 219, 229

addressing, 141-142

avoiding patients with social risk factors, 1, 4, 5, 14, 15, 28, 29, 78, 83-84, 88-91, 327, 348, 419, 435

between-provider/between-plan adjustments and, 14, 81-83, 88, 89, 330

categories, 5, 78

direct adjustment of payments and, 15, 88-89, 95

disincentives to improve quality and efficiency, 5, 14, 15-16, 28, 29, 71, 78, 83, 85, 88-91, 111, 142, 327, 336, 337, 346, 347, 419, 427, 435, 476

insurance coverage denial, 418

minimizing/mitigating, 79, 84-92, 110-112, 141-142, 337

monitoring data for, 2, 37-38, 85, 91, 102, 332, 438

negative symbolic value, 5, 16, 80-81, 88-91, 328, 419

obscuring health disparities, 5, 16, 28, 29, 78, 85, 88-91, 93, 111, 139, 141, 142, 328, 337, 347, 420, 476

patient characteristics within reporting units and, 16, 81, 141-142

of performance measure score adjustment, 14, 82, 88-89, 111-112, 139-140

reporting unit characteristics and, 81

restructuring payment incentive design, 78, 90-91

standards of care, 80-81

status quo of value-based payment (VBP) programs and, 1, 2, 3-4, 28-29, 37-38, 78, 81, 82, 86, 88, 90, 95, 327-328, 337, 346, 417- 420, 435, 438, 537

of stratified public reporting, 16, 78, 80-81, 88-89

underpayment/diminished resources of safety-net providers, 3-4, 14, 27-28, 83, 84, 103, 105, 111-112, 139-140, 141, 142, 229, 230, 242, 336, 418, 435

Urbanicity/rurality (see also Rurality)

and access to health care, 189, 385

built environment, 187

categories, 188-189

and clinical processes of care, 121, 189, 385

and costs of health care, 121, 189, 385

data sources and collection, 64, 100, 463, 499, 501, 506, 516-517, 523, 538

defined, 64, 385, 398, 463, 500

and health and health care, 188-189, 385, 507

and health care resources, 189

measures and measurement issues, 64, 324, 385, 387, 399, 463, 500-501, 507, 528

and neighborhood deprivation, 189, 385, 506, 507, 523

and patient experience, 121, 189, 385

and payment adjustments for hospitals, 209

provider versus patient, 64, 385, 500

and quality of care, 209, 239, 385

recommendation, 463, 499, 538

residential and community context, 64-65, 188-189, 326, 385, 389, 398-399

social environment, 188

urbanization, 121, 188-189

and utilization of health care, 121, 189, 385

value/stability as indicator, 326, 385, 389, 398-399, 457, 479, 496, 499, 538

U.S. Census Bureau data, 63, 64-65, 100, 324, 325 n.2, 383, 385, 387, 398, 460, 463, 466, 489, 501, 506, 507-508, 516, 517, 523

U.S. Department of Health and Human Services (HHS)

gender identity data, 58

Office for Civil Rights, 57, 503

payment goals for Centers for Medicare & Medicaid Services (CMS), 25

standards for racial categories, 55

Suggested Citation:"Index." 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.
×

U.S. Department of Housing and Urban Development (HUD), 386, 467, 526

Healthy Communities Index, 65, 511

U.S. Department of Veterans Affairs (VA), 172

Utilization of health care services

community composition and, 120

community context and, 121

education and, 118, 161, 164-165, 183, 185

health literacy and, 121, 190-191, 388

housing and, 186, 187, 290, 386

income and, 118, 161, 162, 164, 182, 183, 184, 188, 290, 367

language proficiency and, 119, 174, 176

living alone and, 120, 180, 380

marital/partnership status and, 120, 179, 379

Medicare quality measure examples, 116, 150

nativity and, 176

neighborhood deprivation and, 183-184, 188

occupation and, 118, 165, 185

race and ethnicity and, 119, 121, 168-169, 173, 191-192, 267, 350, 365, 374

social support and, 120, 180, 181, 279, 381

urbanicity/rurality and, 121, 189, 385

V

Value-based payment in Medicare (see also Medicare; Methods to account for social risk factors; Unintended consequences of accounting for social risk factors)

for ambulatory care, 135-137, 209-212

bonus payments, 3, 15, 24, 27, 84, 86, 90, 110 n.1, 129, 132, 137 n.4, 140, 209, 212-213, 315, 327, 330, 410, 413, 418, 428, 432-433, 434, 437, 455, 475 n.1, 485

bundled payments, 24-25, 109, 125, 137, 219, 315, 327, 335, 410, 416, 434

Bundled Payments for Care Improvement (BPCI) Initiative, 110 n.1, 127 n.1, 335, 415, 416

Centers for Medicare & Medicaid Services goals, 25, 409, 410

clinical process measures, 116, 128, 135, 208-209, 241

committee process, 115, 117, 149-151

Comprehensive Primary Care Plus, 327, 417

current programs, 110, 127-139, 411-414

data on social risk factors, 458, 482

domains of performance indicators, 33

with downside risk, 110, 130-131, 136-137, 211-212, 326, 412-413

End-Stage Renal Disease Quality Improvement Program, 110, 130-131, 136-137, 211-212, 326, 412-413

future directions, 139

goals, 3, 24, 25, 77, 109, 414-415

for health plans, 137-138, 212-213

Home Health Value-Based Purchasing, 110, 132-133, 138-139, 327, 414

Hospital-Acquired Condition Payment Reduction program, 110, 128, 135, 208, 326, 411

hospital inpatient care, 134-135, 207-209

Hospital Readmissions Reduction Program, 15, 27, 30, 79, 92-96, 110, 128-129, 134, 139, 140, 144, 207, 219, 230, 326, 411

Hospital Value-Based Purchasing program, 95, 110, 128, 135, 140, 208-209, 326, 411-412

incentive payments for participation in, 415

innovative models under testing, 327

Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), 110, 127, 327, 410, 415

Medicare Advantage/Part C, 93, 110, 116, 126, 127, 132-133, 137, 150, 212-213, 221, 233, 240, 289, 315, 327, 409, 410-411, 413, 418, 432

Medicare Part D, 93, 110, 116, 126, 132-133, 137, 138, 150, 163, 173, 212, 213, 221, 233, 240, 315, 327, 409, 410-411, 413-414, 465, 505

Medicare Shared Savings Program, 110, 128-129, 135-136, 209-210, 326, 412-413

Suggested Citation:"Index." 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.
×

monitoring disparities, 80

Next Generation Accountable Care Organizations (ACOs), 327, 415, 416-417

overview of programs, 115, 117, 207

patient safety measures, 116, 120, 128, 132, 135, 137, 150, 208, 209, 411, 412

pay-for-performance, 24, 109, 125, 135, 136, 141, 315, 335, 410, 412, 418, 455 n.1, 475 n.1

Physician Value-Based Modifier, 136, 210-211, 326, 412, 415

population-based payments, 287, 315, 327, 409, 410, 434, 455

population health approach, 25

for post-acute care, 138-139

and provider risk, 24-25, 125, 315, 335, 455, 475

and racial disparities, 141

readmission measures, 92, 132, 207, 213-214, 414

reinsurance, 138, 213, 327, 413

risk corridors, 110 n.1, 133, 137 n.4, 138, 213, 327, 413-414

Skilled Nursing Facility Value-Based Purchasing, 110, 112-113, 138, 213-214, 327, 414

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

with upside gainsharing and downside risk, 110, 128-129, 135-136, 209-210, 326, 412-413

W

Wealth

data sources and collection, 53-54, 466, 490, 496, 508-509, 522-523

disabilities and, 162, 371, 372

dual eligibility as proxy, 52, 53-54, 68, 371, 372, 500, 509, 522

gender and, 53, 370

and health and health care, 53, 162, 319, 370, 373, 466, 508

and health equity, 23, 345

and housing, 370, 508

and income, 53, 54, 55, 118, 162, 167, 183, 370, 374, 466, 508, 509, 522

measures, 53, 370, 466, 508, 539

race and ethnicity and, 53, 55, 167, 370, 374

recommendations, 466, 508, 539

value/stability as indicator, 48, 53, 117, 161, 319, 326, 355, 370, 390-391, 402, 457, 479, 495, 496, 498, 508, 537, 539

Suggested Citation:"Index." 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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Accounting for Social Risk Factors in Medicare Payment Get This Book
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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 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.

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