Accounting for Social Risk Factors in Medicare Payment (2017) / Chapter Skim
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BS: Summary
BS: Summary
Pages 219-228
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, which aims to improve health care quality, health outcomes, and p atient care experiences, while also controlling costs. Since the passage of the Patient Protection and Affordable Care Act in 2010, CMS has implemented a variety of VBP strategies, including incentive programs and risk-based alternative payment models such as bundled (episode-based)
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The committee comprises expertise in health care quality, clinical medicine, health services research, health disparities, social determinants of health, risk adjustment, and Medicare programs (see Appendix F for biographical sketches)
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. The committee also considered using publicly reported performance data from providers relevant to Medicare beneficiaries -- Medicare Hospital Compare hospital data and Medicare Advantage and Medicare Part D Star Ratings health plan data -- to identify high-performing providers disproportionately serving socially at-risk populations.
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Combined with the fact that, as described in the previous section, the committee was unable to identify universally high- or low-performing providers, it follows that it is also problematic to then identify practices associated with the performance of universally high- and low-performing providers, let alone among those disproportionately serving socially at-risk populations, and to make comparisons between them. Thus, the committee turned to case studies to identify specific practices used either to improve performance or achieve high performance for socially at-risk populations or to mitigate the effects of social risk factors on their patient population's health outcomes within specific facilities.
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. Nevertheless, • The committee found examples of specific strategies implemented in specific community contexts by providers serving socially at-risk populations with the goal to improve health care quality and health outcomes.
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Although in reality, a provider simultaneously engages in each systems FIGURE BS-1 Promising systems practices to improve care for socially at-risk populations.
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As health care systems increasingly partner with external organizations and other sectors, this will include non–health care stakeholders as well (e.g., Corrigan and Fisher, 2014)
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health care. New England Journal of Medicine 372(10)
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2014. Health care utilization and r eceipt of preventive care for patients seen at federally funded health centers compared to other sites of primary care.
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2011. Medicaid patients seen at feder ally qualified health centers use hospital services less than those seen by private providers.
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