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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
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ACCOUNTING FOR

Social Risk Factors

IN

Medicare Payment

Committee on Accounting for Socioeconomic Status
in Medicare Payment Programs

Leslie Y. Kwan, Kathleen Stratton, and Donald M. Steinwachs, Editors

Board on Population Health and Public Health Practice

Board on Health Care Services

Health and Medicine Division

A Report of

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THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by Contract No. HHSP233201400020B from the U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-44920-5
International Standard Book Number-10: 0-309-44920-0
Digital Object Identifier: 10.17226/23635
Library of Congress Control Number: 2017931614

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Copyright 2017 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for social risk factors in Medicare payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
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The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

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Learn more about the National Academies of Sciences, Engineering, and Medicine at www.national-academies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
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Reports document the evidence-based consensus of an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and committee deliberations. Reports are peer reviewed and are approved by the National Academies of Sciences, Engineering, and Medicine.

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
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COMMITTEE ON ACCOUNTING FOR SOCIOECONOMIC STATUS IN MEDICARE PAYMENT PROGRAMS

DONALD M. STEINWACHS (Chair), Professor Emeritus, Johns Hopkins Bloomberg School of Public Health

JOHN Z. AYANIAN, Alice Hamilton Professor of Medicine, Director, Institute for Healthcare Policy and Innovation, University of Michigan

CHARLES BAUMGART,1 Senior Medical Director, xG Health Solutions

MELINDA BUNTIN, Professor and Chair, Department of Health Policy, Vanderbilt University School of Medicine

ANA V. DIEZ ROUX, Dean and Distinguished Professor of Epidemiology, Drexel University School of Public Health

MARC N. ELLIOTT, Senior Principal Researcher, RAND Corporation

JOSÉ J. ESCARCE, Professor of Medicine, David Geffen School of Medicine, University of California, Los Angeles

ROBERT FERRER, Dr. John M. Smith, Jr., Professor, Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio

DARRELL J. GASKIN, William C. and Nancy F. Richardson Professor of Health Policy and Director, Johns Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health

MARK D. HAYWARD, Professor of Sociology, Centennial Commission Professor in the Liberal Arts, Faculty Research Associate, Population Research Center, The University of Texas at Austin

JAMES S. JACKSON, Daniel Katz Distinguished University Professor of Psychology, Research Professor, Institute for Social Research, University of Michigan

DANIEL POLSKY, Executive Director, Leonard Davis Institute of Health Economics, University of Pennsylvania

MEREDITH ROSENTHAL, Professor of Health Economics Policy, Harvard T.H. Chan School of Public Health

ANTHONY SHIH, Executive Vice President, The New York Academy of Medicine

Study Staff

KATHLEEN STRATTON, Study Director

LESLIE Y. KWAN, Associate Program Officer

EMILY VOLLBRECHT, Senior Program Assistant (until May 2016)

___________________

1 Resigned in July 2016.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
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ALEXIS WOJTOWICZ, Senior Program Assistant (from May 2016)

REBECCA MORGAN, Senior Research Librarian

DORIS ROMERO, Financial Associate

HOPE HARE, Administrative Assistant

ROSE MARIE MARTINEZ, Senior Board Director, Board on Population Health and Public Health Practice

SHARYL NASS, Board Director, Board on Health Care Services

National Academy of Medicine Greenwall Fellow in Bioethics

BRENDAN SALONER, Assistant Professor, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
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Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

MICHAEL CHERNEW, Harvard Medical School

KAREN COOK, Stanford University

JACK EBELER, Independent Consultant

LISA I. IEZZONI, Harvard Medical School

DAVID NERENZ, Henry Ford Health System

THOMAS H. RICE, University of California, Los Angeles, Fielding School of Public Health

JOSHUA SHARFSTEIN, Johns Hopkins Bloomberg School of Public Health

DOUGLAS O. STAIGER, Dartmouth College

STEPHEN B. THOMAS, University of Maryland

ALAN M. ZASLAVSKY, Harvard Medical School

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
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release. The review of this report was overseen by GEORGES BENJAMIN, American Public Health Association, and CHARLES E. PHELPS, University of Rochester. They were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
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Preface

The Health and Human Services Assistant Secretary for Planning and Evaluation presented the committee with quite a challenge. From a substantive standpoint, the committee was asked to present options for accounting for social risk factors in Medicare value-based payment (VBP) programs. This is a demanding intellectual endeavor, requiring the committee to engage in interdisciplinary thinking, dialogue, analysis, and authorship. From a process standpoint, preparing and releasing five consensus reports in 15 months required a relentless push to think about each piece of this complex problem somewhat in isolation. The crafting of the early reports was done with only a sense of where the entire series would go. Committees of the National Academies of Sciences, Engineering, and Medicine (the National Academies) often have many months to shape and reshape even the very foundation of a report. With this series, the committee finalized work in the hopes that as the rest of the reports developed, the prior efforts remained relevant. I think that the committee has shown in this fifth report that each of the four previous reports provides the foundation for each that followed. I hope the reports are useful to the government, researchers, and the many health care providers who care for socially at-risk populations, who deserve the best health care quality the American health care system can provide.

I would like to thank the National Academies offices that worked efficiently and seamlessly to accommodate the committee’s rigorous timeline. More importantly, I would like to thank the National Academies project staff for their diligence and commitment to excellence and timeliness. Sharyl Nass and Rose Marie Martinez, the directors of the Boards on Health Care

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
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Services and Population Health and Public Health Practice, provided strategic advice and helpful commentary throughout the process. The committee and I are extremely grateful for the expert and speedy research support provided by Leslie Kwan. Finally, we acknowledge the steady hand and experience provided by Kathleen Stratton.

I would also like to thank my fellow committee members. It has been my honor and privilege to work with each and every one of them. Their congeniality, expertise, good humor, and willingness to respectfully question each other and themselves made my job as chair a joy.

Another special thanks goes to the health policy researchers and policy analysts across the country who served as peer reviewers for this series of reports. The timeline was always tight, and they consistently kept to the deadlines. The cogent comments provided helped clarify our thinking and improved the reports immensely. I would particularly like to thank those who reviewed more than one report and, in some cases, all five. That you volunteered so much of your time to participate in multiple reviews in support of the National Academies’ process is admirable, and we are grateful.

Donald M. Steinwachs, Chair
Committee on Accounting for Socioeconomic
Status in Medicare Payment Programs

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
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Recent health care payment reforms aim to improve the alignment of Medicare payment strategies with goals to improve the quality of care provided, patient experiences with health care, and health outcomes, while also controlling costs. These efforts move Medicare away from the volume-based payment of traditional fee-for-service models and toward value-based purchasing, in which cost control is an explicit goal in addition to clinical and quality goals. Specific payment strategies include pay-for-performance and other quality incentive programs that tie financial rewards and sanctions to the quality and efficiency of care provided and accountable care organizations in which health care providers are held accountable for both the quality and cost of the care they deliver.

Accounting For Social Risk Factors in Medicare Payment is the fifth and final report in a series of brief reports that aim to inform ASPE analyses that account for social risk factors in Medicare payment programs mandated through the IMPACT Act. This report aims to put the entire series in context and offers additional thoughts about how to best consider the various methods for accounting for social risk factors, as well as next steps.

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