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ASPE Examines Effects of Social Risk Factors in Medicare Payment Programs

The Office of the Assistant Secretary for Planning and Evaluation (ASPE) has released a report on the effect of social risk factors in Medicare’s value-based payment programs.

The report finds that beneficiaries with social risk factors have worse outcomes on many quality measures, with dual enrollment status being “the most powerful predictor of poor outcomes.” Further, providers such as essential hospitals  that serve a disproportionate share of these beneficiaries have worse performance on quality measures, which is associated with penalties under the hospital readmission reduction program and other value-based purchasing programs.

To account for the effect of social risk factors in Medicare payment programs, ASPE proposes a three-part strategy:

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

The report is the first of two studies required under the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. The second report will examine specific social risk factors not currently available in Medicare data, such as health literacy, limited English proficiency, and the degree to which beneficiaries have the knowledge, skill, and confidence to manage their health care.

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

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About the Author

Maryellen Guinan is a senior policy analyst at America's Essential Hospitals.