This year, the Centers for Medicare and Medicaid Services (CMS) announced a priority to "develop and implement measures that reflect social and economic drivers" at their annual public call to assess recommendations for new measures.
In response, the Physicians Foundation submitted the first-ever social determinants of health (SDoH) measure set for consideration.
It is well-established that SDoH, such as access to housing or healthy food, drive up to 70 percent of health outcomes and associated healthcare costs. But of the nearly 3,000 measures that were submitted to CMS for consideration between 2013 and 2020, not one included SDoH measures.
Should CMS adopt the proposed SDoH measure set, the healthcare industry will be taking a crucial step toward health equity.
Which SDoH measures are included?
For more than a decade, the Physicians Foundation has been a leading voice for physicians across the country and has recognized the impact of social drivers on health outcomes—and the need for the healthcare industry to incentivize and invest in addressing them.
Addressing social drivers with official measures would not only improve patient health and help combat the spread of COVID-19, but would also drive new payment streams for providers—points referenced in the Physician Foundation’s four key principles for including SDoH in healthcare payment and delivery systems.
The proposed measures would create “new standards for SDoH quality, utilization, and outcome measurement.”
Specifically, the new measures focus on the following social drivers:
- Food insecurity
- Housing instability
- Utility needs
- Interpersonal safety
The Foundation notes that these measures have already been well tested through the Accountable Health Communities model, “which has screened nearly a million beneficiaries for SDoH in over 600 clinical practices.”
Furthermore, for each of the SDoH measures adopted, the Foundation recommended that CMS retire three outdated measures, with the goal of re-aligning the healthcare system toward value-based, patient-centered care.
Why does federal recognition matter?
In July, CMS officially included the Foundation’s proposed measure set in its comprehensive list of measures under consideration, which is a major step in advancing SDoH initiatives.
"If made official, they would be the first federal SDoH measures in the history of the U.S. healthcare system,” wrote Physicians Foundation president Dr. Gary Price in a recent Modern Healthcare op-ed.
If approved, the measurements would be applied to two important Medicare programs: the Hospital Inpatient Quality Reporting Program and the Incentive Payment System
However, Dr. Price explains that “if they fail in this last mile, CMS' measurement gap will persist—and, more importantly, we will lose the long-overdue opportunity to bridge the realities of patients' lives and physician practice and the regulatory machinery of our healthcare system.”
How will SDoH measures improve care coordination and delivery?
Social drivers of health are critical comorbidities, as Dr. Price points out. When these social and economic stressors are not measured, screened, and risk-adjusted, patients, providers, and payers miss lifesaving and cost-saving healthcare opportunities.
“A system that does not collect and act on food insecurity data cannot address rising healthcare costs or reduce racial disparities, especially given that Black Americans face the highest rates of both food insecurity and diabetes,” says Dr. Price.
In a Commonwealth Fund piece about the proposed CMS measures, Debbie I. Chang of the Blue Shield of California Foundation and Rachel Nuzum and Corinne Lewis of The Commonwealth Fund argued that health equity is advanced when the industry changes what is measured (and how), stating that “measurement matters because it equips providers with data to identify and address unmet needs and allows policymakers and payers to account for [SDoH] in payment models.”
They further explain that without a standardized measurement tool approved for use by payers and providers, social drivers and the many SDoH initiatives being implemented across the country are unable to be analyzed, rendering data “functionally invisible in federal health care policymaking.”
Including SDoH measurements in federally mandated healthcare screening tools will undoubtedly result in better data, shining a long-overdue light on the social and economic drivers exacerbating healthcare gaps in our communities. Only then can providers, payers, and policymakers truly mobilize and leverage resources in pursuit of health equity.
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Healthify works with payers, providers, and community-based organizations (CBOs) to provide end-to-end solutions to better address social drivers of health. We're strong advocates of new SDoH policies and standards, as they will offer payers and providers more flexibility and financial support to build SDoH solutions that improve health outcomes. Learn more here.