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Should Population-Based Payments Account for Social Risk Factors?
RevCycle Intelligence January 12, 2023
A new study shows that adding social risk factors to risk adjustment models for population-based payments may entrench, not improve, health disparities.
Efforts to make the healthcare system more efficient and equitable by adjusting population-based payments for social risk factors may be missing the mark, suggests a new study from Harvard and Yale. The study published in the latest edition of Health Affairs puts current risk adjustment methodologies under a microscope to find out if they truly support equitable delivery of care.
Researchers tied individual-level predictors of social disadvantage (i.e., race, ethnicity, and educational attainment) to the Hierarchical Condition Categories (HCC) model currently used to risk-adjust payments in Medicare Advantage and benchmarks in the Medicare Shared Savings Program. They...
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