As we begin to see the release of COVID vaccines on the horizon in the United States, it is even more essential to collect robust data on patients’ social needs. This information is critical to providers’ efforts to empower communities and ensure their access to clinical services—and especially to vaccines in the coming year.
Employing a standardized approach to screening for, documenting and coding social needs will enable providers to:
- Track social conditions that affect their patients, allowing personalized care that addresses patients’ medical and social needs.
- Aggregate data across patients to determine how to focus on a strategy to alleviate social risks.
- Identify population health trends and guide community partnerships.
- Stratify quality measure outcomes based on race and ethnicity, to appropriately design patient engagement and outreach that reflect the voice of the community.
Ongoing organizational advocacy and new federal policies are necessary to improve access to vaccines, therapies and social services for vulnerable populations.
CMS programs such as ACO models are necessary to evaluate social needs, in part because they are designed to foster ACO development in underserved areas. Higher proportions of beneficiaries of color score lower overall on quality measures, and may benefit more than higher-risk beneficiaries in ACOs.
Star Rating programs for MA plans, delivery systems, payment transformation efforts and payer-provider risk contracts are a powerful conduit to evaluating and incentivizing quality based on impact on health equity.
As payers and providers engage in discussions about gaps in care, contract renewals and quality program performance, this is their opportunity to identify mechanisms for reducing health disparities and avoiding inadvertent widening of inequalities. Value-based contractors must discuss documentation readiness, incentives related to quality and patient segmentation and patient engagement initiatives to stratify for race, ethnicity, disability, gender and language—at a minimum.
- What do you suggest for participants in CMS, Medicaid waivers, Delivery System Reform Incentive Payment (DSRIP) initiatives or other value-based or alternative payment models to capture and stratify quality programs by social determinants?
- How are payers and providers incentivized to reduce disparities? Do bonus payments for providers or plans reduce disparities?
- How can payers’ enrollment and member engagement initiatives include community engagement and plans to alleviate health disparities in risk-based contracts and quality programs?