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Accounting for social risk in value-based payment and quality measurement
Accounting for social risk in value-based payment and quality measurement
- Collection:
- Health Policy and Services Research
- Author(s):
- Skopec, Laura, author
Garrett, Bowen, author
Zuckerman, Stephen, author - Contributor(s):
- Health Policy Center (Urban Institute), issuing body.
Urban Institute, issuing body. - Publication:
- Washington, DC : Urban Institute, August 2022
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Health Equity -- economics
Health Policy
Quality Assurance, Health Care -- economics
Reimbursement, Incentive -- statistics & numerical data
Socioeconomic Factors
United States - Genre(s):
- Technical Report
- Abstract:
- Social risks, including socioeconomic status, environmental and living conditions, and racial and ethnic discrimination, affect health care and health outcomes. As health care payers like Medicare and Medicaid increasingly focus on paying for value rather than volume, value-based payment (VBP) approaches and quality measures have proliferated. To the extent that social risks outside providers’ control affect health outcomes, VBP approaches could inadvertently penalize providers that see large numbers of patients who face social risks. Public and private health care payers are therefore increasingly grappling with whether and how to account for social risk when measuring quality and paying for performance. To help address these issues, the Urban Institute convened a panel of national experts on April 27, 2022, to discuss accounting for social risk in VBP (box 1). The goal of the panel was to identify policy and technical issues to help the Centers for Medicare & Medicaid Services (CMS) and other policymakers as they consider changes to Medicare, Medicaid, and VBP models to improve health equity and account for social risk. Our findings may also be useful to commercial plans to the extent they engage in VBP with providers. This brief provides key insights from the panel discussion, organized according to the following themes: (1) Adjusting payments and quality measures for social risk is likely necessary to be fair to providers and to preserve access to health care for all beneficiaries, but it is not sufficient to improve equity or reduce disparities. (2) VBP programs and approaches to account for social risk should avoid reinforcing preexisting inequities. (3) In addition to decisions about how to adjust quality measures for risk, the choice of which quality measures to employ could play an important role in promoting equity. (4) Giving providers incentives to improve care quality or reduce disparities via quality measurement and mechanisms to account for social risk differs from investing resources in health equity, and both may be necessary. (5) Data remain a significant limitation in accounting for social risk and improving equity. (6) More research is needed on effective strategies to promote both value and equity in payment and delivery systems. This brief presents background material and summarizes panelists’ comments about the need to consider social risk in VBP and quality measurement. We present the views of multiple experts who attended the meeting and synthesize the discussion.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-DC license. (More information)
- Extent:
- 1 online resource (1 PDF file (17 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918471185506676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918471185506676