This report, mandated by the Improving Medicare Post-Acute Care Transformation Act of 2014 or the IMPACT Act (P.L. 113-185), requires the Secretary, acting through the Assistant Secretary for Planning and Evaluation (ASPE), to conduct research on issues related to socioeconomic status (SES) in Medicare’s value-based payment programs. The term social risk factor is being used in lieu of the term SES based on the January 2016 National Academies of Sciences, Engineering, and Medicine’s report which recommended reframing as such. This Report to Congress provides a study examining the effect of individuals’ social risk factors on quality measures, resource use, and other measures under the Medicare program, as well as analyses of the impact of Medicare’s current value-based payment programs on providers serving socially at-risk beneficiaries and simulations of potential policy options to address these issues.
There is growing recognition that social risk factors – such as income, education, race and ethnicity, employment, community resources, and social support – play a major role in health, and significant gaps remain in health and in life expectancy based on income, race, ethnicity, and community environment. At the same time, the health care system is moving towards value-based or alternative payment models, which tie payment to the quality and efficiency of health care delivered. These models are in place in nearly all Medicare settings, including in hospitals, outpatient settings, and post-acute facilities. In order to properly align payments and ensure value-based purchasing programs achieve their intended goals, the relationships between social risk and performance on these programs need to be better understood. This report shares empirical analysis using existing Medicare data to help address these questions and provides considerations for policymakers while additional work using other data sources continues.