NAM report identifies social risk factors that may influence Medicare measure performance

The National Academy of Medicine today released a conceptual framework for how social risk factors may influence health care use, outcomes and costs in Medicare payment and quality programs. The framework identifies five social risk factors that are likely to influence health care outcomes and quality measures, based on a literature search: socioeconomic position; race, ethnicity and cultural context; gender; social relationships; and residential and community context. The report also identifies examples of relevant Medicare quality measures, including certain hospital admission, readmission and experience of care measures, among others. “Future work of the committee will address the question of whether a specific social factor could be incorporated into Medicare payment programs, the methods to do so, and data needs to accomplish the task,” the committee said. The Department of Health and Human Services asked the NAM to convene the committee, which will also identify best practices of high-performing hospitals, health plans and other providers that serve disproportionately higher shares of socioeconomically disadvantaged populations. Akin Demehin, AHA senior associate director of policy, said, “This important report provides evidence-based confirmation of what hospitals and many policymakers have long known – socioeconomic and other social risk factors matter greatly in measuring the quality of hospitals.”