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.

Contents

• The National Academies of SCIENCES • ENGINEERING • MEDICINE
• COMMITTEE ON ACCOUNTING FOR SOCIOECONOMIC STATUS IN MEDICARE PAYMENT PROGRAMS
• Reviewers
• Preface
• Summary
  • STATEMENT OF TASK
  • THE COMMITTEE'S GOALS
  • SOCIAL RISK FACTORS AND INDICATORS
  • DATA SOURCES
  • GENERAL CONSIDERATIONS ABOUT SOCIAL RISK FACTOR INDICATORS
  • METHODS TO ACCOUNT FOR SOCIAL RISK FACTORS
  • MOVING FORWARD
  • CONCLUDING REMARKS
  • REFERENCES
• 1. Introduction
  • STATEMENT OF TASK
  • THE COMMITTEE'S APPROACH
  • OVERVIEW OF THIS REPORT
  • REFERENCES
• 2. Social Risk Factors: Definitions and Data
  • DEFINITION, EVIDENCE, AND DATA SOURCES
  • GENERAL CONSIDERATIONS
  • REFERENCES
• 3. Methods to Account for Social Risk Factors
  • A. STRATIFIED PUBLIC REPORTING
  • B. ADJUSTING PERFORMANCE MEASURE SCORES
  • C. DIRECT ADJUSTMENT OF PAYMENT
  • D. RESTRUCTURING PAYMENT INCENTIVE DESIGN
  • GENERAL CONSIDERATIONS FOR MITIGATING UNINTENDED CONSEQUENCES
  • HOSPITAL READMISSIONS REDUCTION PROGRAM EXAMPLES
  • REFERENCES
• 4. Moving Forward
  • FUTURE RESEARCH
  • SYSTEMS PRACTICES FOR THE CARE OF SOCIALLY AT-RISK POPULATIONS
  • CONCLUDING REMARKS
  • REFERENCES
• APPENDIXES
  • A. Identifying Social Risk Factors
  • B. Systems Practices for the Care of Socially At-Risk Populations
  • C. Criteria, Factors, and Methods
  • D. Data
  • Appendix E. Prior Conclusions and Recommendations
  • F. Committee Biosketches

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.