There has been lots of talk – and lots of coverage – of the impact of social determinants of health (SDH) on health care costs. Our coverage on the topic has been some of the most-read OPEN MINDS Circle articles of the past year – Hospital Readmission Risk Due To Socioeconomic Factors Varies By Condition, Social Determinants, Health Care Outcomes, & Health Care Costs – A Look At The Numbers, and Strategies For Addressing The Social Determinants Of Health.
But, the next step is figuring out how to “adjust” the health care system and health care reimbursement to consider the impact of social determinants – and that step is just starting (see Social Services Paid By Health Plans? and Lifestyle Interventions Get The Medicare Greenlight).
Last year the National Quality Forum (NQF) panel recommended that SDH factors should be included in risk adjustment if a connection can be made between that SDH and a specific quality metric (see Medicare’s Path To Incorporating Social Determinants Into Value-Based Payment). And just last month – and in accordance with the Improving Medicare Post-Acute Care Transformation (IMPACT) Act – the Office of the Assistant Secretary For Planning and Evaluation delivered a report to congress, Social Risk Factors And Performance Under Medicare’s Value-Based Purchasing Programs, which found:
- Beneficiaries with social risk factors had worse outcomes on many quality measures, regardless of the providers they saw, and dual enrollment status was the most powerful predictor of poor outcomes.
- Providers that disproportionately served beneficiaries with social risk factors tended to have worse performance on quality measures, even after accounting for their beneficiary mix.
- Under all five value-based purchasing programs in which penalties are currently assessed, these providers experienced somewhat higher penalties than did providers serving fewer beneficiaries with social risk factors.
In response to this report to Congress, an article in The New England Journal Of Medicine (see Should Medicare Value-Based Purchasing Take Social Risk into Account?) suggests three strategies to move Medicare closer to simultaneously embracing SDH and the quality measures necessary for value-based care. Their strategy recommendations?
Measure and report quality of care for beneficiaries with social risk factors – To make that happen, the field will need enhanced statistical techniques developed to allow for the necessary measurement and reporting of performance on measures.
Set high, fair quality standards for care of all beneficiaries – While not all current measures can be adjusted for SHD, all measures should be examined to determine whether an adjustment can be made for social risk.
Reward and support better outcomes for beneficiaries with social risk factors – This strategy accepts that value-based methods are key to improving SDH for at-risk populations, and involves four approaches. The first, creating SDH targeted financial incentives to reward achievement or improvement specifically for socially at-risk beneficiaries. The second, to do this using existing or new quality-improvement programs to provide targeted technical assistance to professionals and provider organizations that serve consumers with higher social risk factors. Finally, developing demonstrations for innovations to improve outcomes for consumers with SDH risk but aren’t testable under current payment and delivery structures – while researching the costs of achieving good outcomes for consumers with SDH risk and determining whether current financing accounts for differences in care needs.
It appears that the path forward is to add SDH to value-based reimbursement models throughout health and human services. A development that will provide great opportunity for both health care provider organizations serving these consumers – and social service organizations as well. To stay ahead of the curve, check out these resources in the OPEN MINDS Circle Industry Library:
- Texas Foster Care Redesign Estimated To Generate ROI Of $3 To $1
- Need Financing For Your Next Big Service?
- Bringing Better Value To Services For Justice-Involved Consumers
- “Smart Justice” – A Coordinated Approach For Reducing Recidivism In The Corrections System
- Making The Connection Between Health Care Costs & Social Support Services
- A “New” Justice Involved Population
- Are Medicaid Managed Care Plans Ready For The Justice-Involved Consumer?
- Social Determinants Of Health & Medical Homes
- The ROI Of Recidivism Prevention
For more on the strategies of keeping your organization profitable during a transition to value-based care, be sure to join the OPEN MINDS team at The OPEN MINDS Strategy & Innovation Institute on June 7 for the session, “The Inside Perspective On Medical Homes & Health Homes: Learning From The Experience Of Provider Organizations.”