Social risk factors like income, education, race and ethnicity could have profound effects on value-based care, according to a HHS report.
Here's what you should know.
1. If low-quality care yields poor outcomes for patients with social risk factors, value-based care may drive change for this population. However, if risk factors themselves cause poor outcomes for patients, value-based care could be detrimental.
If providers feel they can't have significant influence on the outcome, HHS believes they may become "reluctant to care for beneficiaries with social risk factors, out of fear of incurring penalties due to factors they have limited ability to influence."
2. HHS believes patients with social risk factors have the most to gain from value-based care.
3. HHS reviewed several social risk factors and compiled their major findings in a report.
- HHS found that patients with risk factors had poor outcomes on several quality measures regardless of the provider.
- Dual enrollment status was the most powerful predictor of poor outcomes.
- Providers that partially served patients with risk factors had poor performance on quality measures. These providers would've experienced higher penalties than those serving fewer patients with risk factors.
4. HHS recommended three solutions:
- Adjusting the measure and report quality for Medicare beneficiaries with social risk factors
- Setting high and fair quality standards for all beneficiaries
- Rewarding and supporting better outcomes for beneficiaries.
HHS believes if implemented, those three solutions "may help ensure that all Medicare beneficiaries can achieve the best health outcomes possible."