Adjusting Health Care Payments for Social Risk Is Critical for Addressing Patients’ Social Needs
Social determinants of health have greater influence on health than health care, yet Medicare and most other payers have held out on adjusting payments to better support clinicians’ capacity to address social needs. In 2014, the US Congress charged the Secretary of Health and Human Services with answering whether and how to accomplish this. And while a series of reports commissioned of the National Academies of Sciences, Engineering, and Medicine (NASEM) recommended the need for such payment adjustments, the Secretary has not delivered a policy.
A new Health Affairs Blog by Drs. Bob Phillips, Andrey Ostrovsky, and Andrew Bazemore reports on a policy design workshop of stakeholders including staff from CMS, the Center for Medicare & Medicaid Innovation (CMMI), the Assistant Secretary for Planning and Evaluation (ASPE), and the Agency for Healthcare Research and Quality (AHRQ), two leaders of state Medicaid social determinants policy, state health planners, health care payers, consumers, providers, and several social determinants researchers. The workshop produced consensus on a demonstration model for a payment adjustment based on census-tract level social deprivation indices. The authors state, “The use of small-area-based indices of social risk increases the likelihood of aligning health care resources with population needs in the most reliable and transparent manner.” A series of follow up workshops aim to help Health and Human Services arrive at viable policy options faster and with more stakeholder participation.
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