There’s a growing wave of interest to incorporate social determinants of health into public health, and in a value-based model of care, these factors may carry a lot of sway.
Today, the National Academies of Sciences, Engineering, and Medicine released a report that suggests Medicare could incorporate such determinants into its funding of senior care. The report, “Accounting for Social Risk Factors in Medicare Payment: Criteria, Factors, and Methods," is the third in a series of five reports on social determinants of health concluded it possible the Centers for Medicare & Medicaid Services could account for several social risk factors in Medicare’s value-based payment programs. Those factors include: income, education, and dual eligibility; race, ethnicity, language and nativity; marital/partnership status and living alone; and neighborhood deprivation, urbanicity and housing, according to the Academies release.
“It’s critically important to get a fair and accurate assessment and that these social determinants of health be accounted for in the quality measures that are used to assess value,” says Nancy Foster, vice president, quality and patients safety policy, American Hospital Association.
Currently, CMS payment programs don’t account for social risk factors, which can create further disparities in health. If a provider is using more resources to achieve similar health outcomes for their vulnerable populations, they may receive lower quality rankings and penalties under value-based care payment models.
“When you’re looking to evaluate hospitals it’s important you’re focusing on the piece of the puzzle over which they have the most control, rather than ascribing to hospitals the factors that may be beyond their control,” says Akin Demehin, director of policy, American Hospital Association.
The National Academies committee found four categories, and 10 methods on how to account for social determinants in Medicare value-based payment programs. They are:
- Stratified public reporting, which seeks to make quality of care for socially at-risk and other patients visible to consumers, providers, payers, and regulators;
- Adjustment of performance measure scores, which accounts for social risk factors statistically, in an effort to more accurately measure true performance;
- Direct adjustment of payments, which explicitly uses measures of social risk factors in payment but by itself does not affect performance measure scores; and
- Restructuring payment incentive design, which implicitly accounts for social risk factors in payment.
Addressing the Problem
Meanwhile, Health Leads, a not-for-profit focused on addressing social co-morbidities in patient care, has released their first in a series of toolkits designed to help hospitals and clinicians implement a system to screen patients for social needs during their visit.
“Right now, we live in an era of patient-centered care, so addressing patients’ social needs really shouldn’t be seen as a higher standard of care — we think of it as a minimum standard of care.” says Rocco Perla, President, Health Leads. “And a growing number of health systems are recognizing that unless they address patient social needs directly, they simply can’t practice patient-centered and equitable care.”
Inside the toolkit are the most common areas of social need, detailed screening best practices, which includes guidance on developing questions suited to individual workflow, a sample screening tool to be adapted for a specific population, and a host of questions based around the most common unmet social needs.
Everything inside the toolkit is based on guidelines from the Institute of Medicine, CMS, Centers for Disease Control and Prevention and the Agency for Healthcare Research Quality.
Health Leads is also working on future toolkits that would help capture, analyze and share social needs data through Electronic Health Records and workforce guidelines for establishing a social needs workforce, says Perla.
“Screening is often the first place people start,” says Zach Goldstein, principal of innovation at Health Leads. “Unfortunately, there’s really no standard screening tool to look for a place to start. Our goal was to help create the standard and to help people understand, if you want a starting point, here’s what that starting point could look like."