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NAM Issues Report on Social Risk Factors in Medicare Programs

A new National Academy of Medicine (NAM) report identifies five social risk factors that can impact health care utilization and presents a conceptual framework for how social risk factors influence health care use, outcomes, and cost in Medicare payment and quality programs.

The consensus report is the first of five from a NAM ad hoc committee working to identify social risk factors that affect the health outcomes of Medicare beneficiaries, and methods to account for these factors in Medicare programs. Through a literature review, the committee identified these social risk factors for health care utilization:

  • socioeconomic position
  • race, ethnicity, and cultural context
  • gender
  • social relationships
  • residential and community context

The report also lists quality measures these social factors might impact, including hospital admission, readmission, and patient experience measures. Subsequent work will focus on specific factors that could be incorporated into Medicare programs, the methods to do so, and data needs, the committee said.

America’s Essential Hospitals has been a leading advocate for risk-adjustment based on socioeconomic status for measures in Medicare quality programs to ensure that hospitals caring for vulnerable patients are not disproportionately and unfairly penalized for the challenges their patients face.

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

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About the Author

Matt Buechner is the policy and advocacy associate for America's Essential Hospitals.

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