Skip to main content

Currently Skimming:

Summary
Pages 1-15

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 1...
... . Stakeholders have raised concerns that current Medicare quality measurement and payment programs, and VBP programs in particular, that do not account for social risk factors may underestimate the quality of care provided by providers disproportionately serving socially at-risk populations.
From page 2...
... In the first report, the committee presented a conceptual framework and described the results of a literature search linking five social risk factors and health literacy to healthrelated measures of importance to Medicare quality measurement and payment programs -- referred to in this report as performance indicators used in VBP. In the second report, the committee reviewed the performance of providers disproportionately serving socially at-risk populations, discussed drivers of variations in performance, and identified six communityinformed and patient-centered systems practices that show promise to improve care for socially at-risk populations.
From page 3...
... in their 2014 report Risk Adjustment for Socioeconomic Status or Other Sociodemographic Factors. Like NQF, the committee's criteria explicitly focuses on selecting risk factors that will be applied to adjustment of performance indicators used for VBP.
From page 4...
... This category is the most basic pair of criteria for a social risk factor -- that there be both a plausible and valid reason why the risk factor would be associated with the outcome and empirical evidence that such a relationship holds in practice. Together these criteria lay the foundation for the validity and practical importance of the risk factor.
From page 5...
... Prioritize continuous over dichotomous measures of the same construct where applicable to reduce "edge" gaming. Carefully monitor high-leverage factors (i.e., risk factors that are not prevalent but highly predictive of outcomes)
From page 6...
... Figure S-1 illustrates the primary hypothesized relationships between social risk factors and health literacy and performance indicators used in VBP. The committee applied the selection criteria they developed to the five social risk factors (and their respective indicators)
From page 7...
... For thhe 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 a r ms rt-term, italicized lettering denotes g measurable indicators that capture th basic unde t he erlying constr ructs and curr rently present practical t challenges, but are wor attention for potential inclusion in ac rth f i ccounting me ethods in Med dicare value-bbased payment programs in th longer term and plain lettering deno indicators that have co p he m; l otes s onsiderable limitation ns. a As described in th conceptua framework outlining prim d he al mary hypothe esized concep ptual relations ships between social risk fac s ctors and outccomes used in VBP present in the com n ted mmittee's firs report (NAS st SEM, 2016a)
From page 8...
... 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 9...
... Nevertheless, it may be desirable to otherwise compensate providers for the greater effort or costs required to provide health literate care and thereby produce good health care outcomes. After applying the selection criteria to indicators of the five social risk factors and health literacy, the committee made the following conclusions: Conclusion 2: There are measurable social risk factors that could be accounted for in Medicare value-based payment programs in the short term.
From page 10...
... These include • Wealth, • Acculturation, • Gender identity and sexual orientation, • Emotional and instrumental social support, and • Environmental measures of residential and community context. METHODS TO ACCOUNT FOR SOCIAL RISK FACTORS IN VALUE-BASED PAYMENT PROGRAMS When developing and selecting methods to account for social risk factors in VBP programs, understanding the type of incentive design is important for evaluating the potential benefits and challenges of various accounting methods.
From page 11...
... Potential Harms of the Status Quo Compared to Accounting for Social Risk Factors Although adjustment for social risk factors could have important benefits, any proposal to account for social risk factors in Medicare payment programs will entail its own advantages and disadvantages that need to be carefully considered. The status quo (which does not account for social risk factors)
From page 12...
... restructuring payment incentive design -- encompassing ten methods to account for social risk factors that could be used to address policy goals of reducing disparities in access, quality, and outcomes; quality improvement and efficient care delivery for all patients; fair and accurate public reporting; and compensating providers fairly. Public reporting seeks to make overall quality visible -- to consumers, providers, payers, and regulators (IOM, 2006)
From page 13...
... Adjustment is a means to account for social risk factors statistically in an effort to more accurately measure true performance. Methods to adjust performance measure scores include (1)
From page 14...
... Conclusion 8: Any specific approach to accounting for social risk factors in Medicare quality and payment programs requires continuous monitoring with respect to the goals of reducing disparities in access, quality, and outcomes; quality improvement and efficient care delivery for all patients; fair and accurate public reporting; and compensating providers fairly. Finally, because behavioral and other responses to new systems may change the balance of risks and benefits over time, to take into account these behavioral and other responses, the specific approach to accounting for social risk factors may need to be reassessed.
From page 15...
... 2016a. Accounting for social risk factors in medicare payment: Identifying social risk factors.


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.