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Pages 1-16

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From page 1...
... , to the extent that social risk factors influence performance indicators independently of provider actions and those factors are unevenly distributed across providers, it may be appropriate to account for social risk factors in 1 As described in the committee's first and third reports (NASEM, 2016a,b) , CMS payment models cover a spectrum of approaches from traditional fee-for-service to population-based payment models.
From page 2...
... The committee also concluded that some indicators of social risk factors capture the basic underlying constructs and currently present practical challenges, but they are worth attention for potential inclusion 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 3...
... If CMS collects new social risk factor data, it could design measures and data collection methodologies to ensure collection of accurate data that meet the needs of the intended method to account for those social risk factors in Medicare quality measurement and payment. New data collection would not be subject to the potentially substantial barriers of collaborating with other federal government agencies, but it would require substantial cost.
From page 4...
... and state agencies oversee and maintain and that could be linked to Medicare beneficiary data. This includes data that could be linked to Medicare beneficiary data at the individual level, arealevel data that could be used to describe a Medicare beneficiary's residential environment or serve as a proxy for individual effects, and data that could help CMS to determine how to elicit information on social risk factors from Medicare beneficiaries.
From page 5...
... They all capture social risk factor data that could be useful to CMS when determining how best to elicit information from Medicare beneficiaries on their social risk factors. The primary advantage of using administrative and survey data from other agencies is that these data sources contain substantial information on social risk factors, and data from these sources are collected using standardized and validated measures and methodologies.
From page 6...
... • Where social risk factors change over time and have clinical utility, requiring data collection through electronic health records or other types of provider reporting may be the best approach. • For social risk factors that reflect a person's context or environment, existing data sources that can be used to develop area-level measures should be considered.
From page 7...
... 4. Some measures exist, but more research is needed on the effect of the social risk factor indicator on health care outcomes of Medicare beneficiaries and on methods to accurately collect data for the Medicare population.
From page 8...
... In the long term, research is needed on measurement and data collection for partnership. In particular, CMS could examine whether including partnership in any method to account for social risk factors that already includes marital status and living alone adds substantial additional precision and explanatory value.
From page 9...
... Living alone is a structural element of social relationships, which is typically an indicator of social isolation or loneliness, and it is likely to capture elements of social support (Berkman and Glass, 2000; Brummett et al., 2001; Cohen, 2004; Eng et al., 2002; House et al., 1988; Wilson et al., 2007)
From page 10...
... Recommendation 6: The committee recommends that research be conducted on the effect of acculturation, sexual orientation and gender identity, and environmental measures of residential and community context on health care outcomes of Medicare beneficiaries, and on methods to accurately collect relevant data in the Medicare population. Acculturation describes how much an individual adheres to the social norms, values, and practices of his or her own home country or ethnic group or to those of the United States (NASEM, 2016a)
From page 11...
... are strongly associated with health and health care outcomes, despite the fact the gender effects are difficult to separate from biological sex effects. Thus, normative gender is a strong candidate for inclusion in methods to account for social risk factors in Medicare quality measurement and payment programs.
From page 12...
... F EHR dat er, fic ion may For ta, needs for complemen r ntary modes may diminish with adva ances in EHR adoption a R and interoperrability. An example of an existing multimodal a e a m approach is C CMS's strate for egy collecting race and et g thnicity data Data from beneficiarie enrolled since the 199 are collec a.
From page 13...
... . Conclusion 2: Different data collection strategies for the same social risk factor indicator may be warranted depending on the purpose or methods used to account for social risk factors in Medicare performance measurement and payment.
From page 14...
... 2016a. Accounting for social risk factors in Medicare payment: Identifying social risk factors.
From page 15...
... 2012. The validity of race and ethnicity in enrollment data for Medicare beneficiaries.


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