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ASPE Examines Effects of Social Risk Factors in Medicare Payment Programs

The Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation (ASPE) released a second report on the effects of social risk factors in Medicare’s value-based purchasing programs (VBP).

ASPE is required under the Improving Medicare Post-Acute Care Transformation Act of 2014 to release two reports on this subject; the first report was released in 2016.

In this second report, the agency describes three major findings:

  • there is no systematic collection or standardization of beneficiary social risk information across the health care system;
  • dual enrollment in Medicare and Medicaid remains a powerful predictor of poor outcomes on some quality and resource use measures in Medicare’s VBP programs, even after accounting for some risk factors; and
  • there are limited evaluation efforts to identify which social risk interventions are most effective, replicable, and scalable.

As a result of these findings, ASPE offers a series of recommendations based on a three-part strategy focused on beneficiaries with social risk factors:

  • measure and report quality;
  • set high and fair quality standards; and
  • reward and support better outcomes.

ASPE made several recommendations regarding collecting and sharing data on social risk. With respect to Medicare quality reporting and VBP programs, ASPE suggests not adjusting certain measures for social risk in public reporting, such as quality and outcomes measures, and composite scores, such as star ratings.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Abigail Painchaud is a policy associate at America's Essential Hospitals.

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