Accounting for Social Risk Factors in Medicare Payment Criteria, Factors, and Methods (2016) / Chapter Skim
Currently Skimming:
3 Applying Selection Criteria to Social Risk Factors and Health Literacy
3 Applying Selection Criteria to Social Risk Factors and Health Literacy
Pages 39-73
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 39... ...
, the committee expects the effect of social risk factors to be similar for all Medicare subpopulations. As described in its first report, the committee considers variations in the effect of social risk factors among beneficiaries under age 65 with disabilities, beneficiaries age 65 and older, and beneficiaries with ESRD to fall within a continuous spectrum of effects.
|
From page 40... ...
For th he indicators listed in bull under eac social risk factor, bold l ettering deno measurab indicators that s lets ch otes ble could be accounted for in Medicare VBP program in the shor term; italici a r ms rt ized lettering denotes measurable indicators that capture th basic unde t he erlying constrructs and curr rently present practical t challenges, but are wor attention for potential inclusion in ac rth f i ccounting meethods in Med dicare VBP programs in the longer term; and pla lettering denotes indica r ain d ators that hav considerabl limitations. ve le a As described in th conceptual framework outlining prim d he l o mary hypothes sized concept relationsh tual hips between social risk fac s ctors and outc comes used in value-based payment pres n sented in the committee's first report (NA ASEM, 2016a health care use captures measures of utilization an clinical pr a)
|
From page 41... ...
As identified in the committee's first report, literature indicates that income may influence health care utilization, clinical processes of care, health care costs, health outcomes, and patient experience (NASEM, 2016a)
|
From page 42... ...
. Literature supports a conceptual relationship between wealth and health care outcomes of interest, but a lack of available measures and thus evidence of an empirical association present limitations for using wealth as an indicator of SEP.
|
From page 43... ...
Relatedly, dual eligibility may capture clinical characteristics covering those who are under age 65 and eligible for Medicaid coverage based on disability. As noted in the introduction, the committee expects social risk factors to operate similarly among all Medicare beneficiaries including disabled persons.
|
From page 44... ...
. Thus, literature supports a conceptual relationship between education and performance indicators used in VBP.
|
From page 45... ...
Dual eligibility meets practical criteria and can be considered a proxy for SEP as a measure of resources available for goods and services to support health and health care. Occupation is likely to be strongly associated with performance indicators used in VBP, but practical considerations limit its potential use.
|
From page 46... ...
In sum, race and ethnicity are related to health care outcomes, precede care delivery and are not a consequence of the quality of care, are not things a provider can manipulate, and meet practical considerations. At the same time, the committee acknowledges that causal pathways by which race and ethnicity influence health include mechanisms that can be related to quality of care.
|
From page 47... ...
Literature supports a conceptual relationship between acculturation and health care outcomes of interest, but existing measures pose challenges to feasibility. Consequently, there is a lack of empirical evidence about the relationship between acculturation and performance indicators used in VBP.
|
From page 48... ...
. Measures of gender identity are likely to be resistant to gaming or manipulation, but because there is a very low prevalence of gender minorities, gender identity is unlikely to have a significant effect in adjustment models and other methods of accounting for social risk factors.
|
From page 49... ...
In its first report, the committee identified literature indicating that marital status may influence health care utilization, clinical processes of care, health care outcomes, patient experiences of care, and health care costs (NASEM, 2016a)
|
From page 50... ...
. Hence, literature supports a conceptual relationship between social support and performance indicators used in VBP.
|
From page 51... ...
Some evidence suggests that the relationship between marital/partnership status and health is changing along with demographic shifts, which point to a need to reassess the empirical associations and revisit assumptions about the conceptual relationship over time. Emotional social support and instrumental social support are likely to influence health care outcomes.
|
From page 52... ...
. In total, despite some measurement issues, compositional characteristics of residential and community context are related to performance indicators used in VBP, precede care delivery and are not a consequence of the quality of care, are not things a provider can manipulate, and generally meet practical considerations.
|
From page 53... ...
In its first report, the committee identified literature indicating that urbanicity may influence health care utilization, clinical processes of care, health care costs, and patient experiences of care, particularly at the far ends of the spectrum (NASEM, 2016a,b)
|
From page 54... ...
. In its second report, the committee also identified case studies in which housing conditions -- stairs and loose wires -- were considered risk factors for poor health care outcomes (e.g., falls)
|
From page 55... ...
Act and therefore of interest to Congress. Additionally, social risk factors like education and language influence health literacy.
|
From page 56... ...
SYNOPSIS Table 3-1 summarizes the social risk factors as well as health literacy, along with their rationale for inclusion in methods to account for them and potential limitations. In the table, specific criteria as they apply to indicators of social risk factors are indicated using the criteria numbers from the previous chapter (in parentheses)
|
From page 57... ...
4. The social risk factor is not modifiable through provider actions.
|
From page 58... ...
income, so there is still sufficient variation (albeit narrower than the general population) among Medicare beneficiaries Wealth (as an Has a conceptual relationship Salient for Medicare alternate with performance indicators beneficiaries, but sensitive to measure of used in VBP (1)
|
From page 59... ...
Education Has a conceptual relationship Implications for health with performance indicators may vary across age used in VBP (1) cohorts due to changes Has an empirical relationship in the distribution of with performance indicators education over time.
|
From page 60... ...
Race, Ethnicity, and Cultural Context Race and Social categories that are Has a conceptual relationship Refinement of standardized Some existing standards ethnicity dimensions of society's with performance indicators race and ethnicity measures is include White House stratification system by which used in VBP (1) still needed; there can be Office of Management resources, risks, and rewards Has an empirical relationship substantial heterogeneity and Budget standards are distributed; capture a range with performance indicators within categories (especially and IOM of health-relevant dimensions used in VBP (2)
|
From page 61... ...
Documentation status as a measure of immigration history is likely to be sensitive to collect. Literature supports a conceptual relationship between acculturation and health care outcomes of interest, but existing measures have limitations and empirical evidence is lacking.
|
From page 62... ...
Gender identity Includes individuals who Has a conceptual relationship Lack of empirical evidence Very low prevalence, (non- identify as transgender, with performance indicators and a good existing measure unlikely to have a conforming) intersex, queer, questioning, used in VBP (1)
|
From page 63... ...
Social Relationships Marital/ Foundational structural element Has a conceptual relationship Potentially susceptible to partnership of social relationships; often with performance indicators rapid changes (3) status considered an important used in VBP (1)
|
From page 64... ...
Emotional and instrumental social support are strongly related to health care outcomes; some measures exist, but because they are multidimensional and causal mechanisms are poorly understood, measuring social support can be difficult both conceptually and practically. Residential and Community Context Compositional Includes dimensions of SEP, Has a conceptual relationship Can be a messy measure: Can be used as proxy for characteristics the proportion of racial and with performance indicators When used as a proxy for individual characteristics ethnic minority residents, used in VBP (1)
|
From page 65... ...
falls on with performance indicators challenges; need to measure the spectrum from urban to used in VBP (1) at the appropriate size to rural Has an empirical relationship avoid misclassification (2)
|
From page 66... ...
knowledge and skills in a variety of applications across a variety of settings SUMMARY Health literacy is the result of social risk factors and the effects of low literacy can be mitigated via actions that are squarely within the purview of the health care system. Thus, risk adjustment is likely to reduce incentives to tailor care to or improve patients' health literacy.
|
From page 67... ...
Conclusion 3: There are some indicators of social risk factors that capture the basic underlying constructs and currently present practical challenges, but they are worth attention for potential inclusion in accounting methods in Medicare value-based payment programs in the longer term. These include: • Wealth, • Acculturation, • Gender identity and sexual orientation, • Emotional and instrumental social support, and • Environmental measures of residential and community context.
|
From page 68... ...
2000. Social integration, social networks, social support, and health.
|
From page 69... ...
2015. Sexual minorities in England have poorer health and worse health care experiences: A national survey.
|
From page 70... ...
2004. Health literacy: A prescription to end confusion.
|
From page 71... ...
2012. How can health care organizations become more health literate?
|
From page 72... ...
2016a. Accounting for social risk factors in medicare payment: Identifying social risk factors.
|
From page 73... ...
adults: National Health Interview Survey, 2013. National Health Statistics Reports (77)
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.