A recent report from the U.S. Department of Health and Human Services addressed the topic of social risk factors within value-based payment programs. The report acknowledged that patient with specific risk factors could fare worse on certain quality measures. Their providers may perform worse, as well.
This report found that the most powerful poor performance predictor was dual eligibility status – a term that describes people who qualify for Medicare and Medicaid because they are a combination of elderly, disabled, and low-income. The providers who disproportionally serve these patients also tend to perform worse on quality measures, including all the five CMS programs that may penalize hospitals.
The report further explains that value-based payments may help to drive improvements. However, CMS must also guard against any value-based arrangements that could lead some providers to stop serving patients with social risk factors.
These findings were published in Modern Healthcare on December 22, 2016.