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Accounting for Social Risk Factors in Medicare Payment (2017) / Chapter Skim
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Appendix C: Criteria, Factors, and Methods
Pages 311-314

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From page 311...
... This report was originally released on July 13, 2016, as: National Academies of Sciences, Engineering, and Medicine.
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From page 312...
... CONTENTS CS SUMMARY 315 Statement of Task, 316 Criteria for Selecting Social Risk Factors, 317 Applying Criteria to Social Risk Factors and Health Literacy, 318 Methods to Account for Social Risk Factors in Value-Based Payment Programs, 326 Concluding Remarks, 332 References, 332 C1 INTRODUCTION 335 Statement of Task, 338 Committee Process, 338 References, 340 C2 CRITERIA FOR SELECTING SOCIAL RISK FACTORS FOR APPLICATION IN MEDICARE QUALITY MEASUREMENT AND PAYMENT 343 Rationale for Accounting for Social Risk Factors in Quality Measurement and Payment, 343 Guiding Principles, 345 Committee Process, 347 Criteria for Selecting Social Risk Factors, 348 Guidance Regarding the Process for Using Selection Criteria, 358 References, 362 C3 APPLYING SELECTION CRITERIA TO SOCIAL RISK FACTORS AND HEALTH LITERACY 365 Socioeconomic Position, 366 Race, Ethnicity, and Cultural Context, 374 Gender, 377 Social Relationships, 379 Residential and Community Context, 382 Health Literacy, 387 Synopsis, 389 Implementation Considerations, 402 References, 402 312
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From page 313...
... C4 METHODS TO ACCOUNT FOR SOCIAL RISK FACTORS IN MEDICARE VALUE-BASED PAYMENT 409 Incentive Design in Medicare Payment Programs, 410 Potential Harms of the Status Quo Compared to Accounting for Social Risk Factors, 417 Methods to Account for Social Risk Factors in Value-Based Payment Programs, 420 Applying Methods to Account for Social Risk Factors, 434 Monitoring Methods to Account for Social Risk Factors, 438 Concluding Remarks, 439 References, 439 CA CRITERIA FOR SELECTING RISK FACTORS REVIEWED BY THE COMMITTEE 445 CMS-HCC Model Criteria, 445 CAHPS Case-Mix Adjustment Criteria, 448 HHS-HCC Risk Adjustment Model Criteria, 448 National Quality Forum Criteria Guidelines for Selecting Risk Factors for Adjustment, 449 References, 451 313
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Key Terms

  • social risk
  • medicare payment
  • national academies
  • originally released


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