Developing Medicare/Medicaid Policy Options for Social Risk Payment Adjustment
Developing Medicare/Medicaid Policy Options for Social Risk Payment Adjustment
May 12, 2022
Designing Future State to Account for Social Risks in Medicaid Payments
This workshop’s focus is on brainstorming policy options for a future state Medicaid payment system that incorporates social risks in a sustainable, equitable way.
Highlights
On May 12, 2022, 22 CMS & Industry experts gathered at the Cosmos Club in Washington, DC for a workshop focused on the future state of incorporating social risk factors into Medicaid payment adjustments. Additionally, the group discussed ways to ensure social risk-based payments actually address social needs rather than increasing profit margins for health systems and insurers
Key Findings
- Evaluate the role of Medicaid in the SDOH initiative
- Improve access and care by focusing on the patient’s true needs
- Community involvement is vital to addressing diverse problems in a community-based approach
- Patients and families need help navigating services
- There is a disconnect between technology and interoperability
- Variability is necessary in medical care
- Different types of providers require different payment considerations
March 31, 2022
Designing Future State to Account for Social Risks in Medicare Payments
This workshop’s focus is on brainstorming policy options for a future state CMS payment system that incorporates social risks in a sustainable, equitable way.
Highlights
On March 31, 2022, 18 Federal & Industry experts gathered at the Cosmos Club in Washington, DC, to discuss the future state of incorporating social risk factors into Medicare Advantage (MA) payment adjustments. Specifically, the group discussed operational pathways that would ensure social risk-based payments address social needs rather than increasing profit margins for health insurers.
Key Findings
- Patients often do not trust insurers or the healthcare system
- Providers should adapt their practice to address social needs directly or in partnership with community-based organizations (CBOs)
- Beneficiary-specific social need data are difficult to obtain and maintain for the most disadvantaged populations. There is an ethical obligation to address identified social needs; collecting the data is a burden and the inability to address social needs is a source of burnout
- MA plans should fund medical and non-medical providers to enable them to address social needs
- Payment adjustment for social risk should be based a curvilinear relationship rather than thresholds
- Accountability means resources flow through primary care and CBOs to the patient and community
Additional Resources
Acknowledgment of Support
The workshop convenings have been made possible through generous support from The Commonwealth Fund, a national, private foundation based in New York City that supports independent research on health care issues and makes grants to improve health care practice and policy, and Arnold Ventures, a philanthropy dedicated to tackling some of the most pressing problems in the United States through research, education, and advocacy. The views presented here are those of the author and not necessarily those of The Commonwealth Fund and Arnold Ventures, its directors, officers, or staff. Additional support has been provided by the American Board of Medicine Foundation, 3M Health Information Systems, and the Samueli Foundation.
Acknowledgment of Support
The workshop convenings have been made possible through generous support from The Commonwealth Fund, a national, private foundation based in New York City that supports independent research on health care issues and makes grants to improve health care practice and policy, and Arnold Ventures, a philanthropy dedicated to tackling some of the most pressing problems in the United States through research, education, and advocacy. The views presented here are those of the author and not necessarily those of The Commonwealth Fund and Arnold Ventures, its directors, officers, or staff. Additional support has been provided by the American Board of Medicine Foundation, 3M Health Information Systems, and the Samueli Foundation.
