Accounting for Social Risk Factors in Medicare Payment
2017

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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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580 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-44920-0
ISBN Ebook: 0-309-44921-9
DOI: https://doi.org/10.17226/23635

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National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press.

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Front Matter i-xii
Summary 1-22
1 Introduction 23-46
2 Social Risk Factors: Definitions and Data 47-76
3 Methods to Account for Social Risk Factors 77-98
4 Moving Forward 99-106
Appendix A: Identifying Social Risk Factors 107-108
AS: Summary 109-124
A1: Introduction 125-158
A2: Social Risk Factors 159-206
AA: Overview of Medicare Value-Based Payment Programs 207-216
Appendix B: Systems Practices for the Care of Socially At-Risk Populations 217-218
BS: Summary 219-228
B1: Introduction 229-236
B2: Improving Care for Socially At-Risk Populations 237-302
BA: Example Implementation Strategies and Case Studies 303-310
Appendix C: Criteria, Factors, and Methods 311-314
CS: Summary 315-334
C1: Introduction 335-342
C2: Criteria for Selecting Social Risk Factors for Application in Medicare Quality Measurement and Payment 343-364
C3: Applying Selection Criteria to Social Risk Factors and Health Literacy 365-408
C4: Methods to Account for Social Risk Factors in Medicare Value-Based Payment 409-444
CA: Criteria for Selecting Risk Factors Reviewed by the Committee 445-452
Appendix D: Data 453-454
DS: Summary 455-474
D1: Introduction 475-480
D2: Potential Data Sources 481-494
D3: Data Sources and Data Collection for Social Risk Factors 495-534
Appendix E: Prior Conclusions and Recommendations 535-540
Appendix F: Committee Biosketches 541-548
Index 549-568

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Accounting for Social Risk Factors in Medicare Payment (2017)

Chapter: Appendix D: Data

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Accounting for Social Risk Factors in Medicare Payment (2017)

Chapter: Appendix D: Data