There's no question that race, gender, socio-economic status and health literacy influence a patient's healthcare access, cost and outcomes.
But what's still fuzzy is an understanding of which factors are within a provider's control, and how to adjust for these factors in value-based payments, a new report says.
The U.S. government has been on an ambitious track to shift the industry toward value-based payment models and is now turning its focus to social factors.
“All other things being equal, the performance of a given health care system can undoubtedly be affected by the social composition of the population it serves,” concludes a report released Tuesday by the National Academies of Sciences, Engineering and Medicine.
In some cases, the system can itself ameliorate the impact of those social risks, the report also asserts.
The report is the first of five commissioned by HHS, which asked the National Academies to look at the issue amid the proliferation of payment reform strategies. The CMS is either financially rewarding or penalizing health providers for their performance using quality metrics that some say are flawed.
The practice has been both complicated and controversial, to say the least.
Critics have complained that a community's socio-economic and demographic features might leave facilities in poorer areas at a disadvantage. Patients in those locations may not be able to afford follow-up treatments or may have limited access to resources, like healthy foods or therapy that leads to better outcomes.
"We don't want to set policies that unfairly penalize providers in vulnerable populations, or policies that drive them away and cause access to care issues," said David Nerenz, director of the Center for Health Policy and Health Services Research at the Henry Ford Health System in Detroit. "At the same time, we don't want policies that mask or excuse true instances of poor quality."
Nerenz is one of eight technical experts chosen to review the new report before its release. He has been studying the impact of social determinants of health at Henry Ford Hospital in Detroit. Many of the patients who visit that 751-bed safety net hospital come from neighborhoods that have low household income, limited access to fresh produce markets and few neighborhood pharmacies.
One often-cited example of the issue is mounting concern over the CMS' readmission measure, which tracks how frequently patients return to the hospital within 30 days of being discharged.
The federal agency began cutting payments for excessive readmissions in October 2012. Most recently, a study in Health Affairs suggested that where patients go when discharged—a factor the CMS isn't measuring—could play a key role in whether or not they get re-hospitalized.