American Board of Family Medicine (ABFM)
Overall, social determinants have a greater impact on health than healthcare itself. However, Medicare, Medicaid, and most other payers have not yet adjusted their payments to better support healthcare providers.
Social-needs payment adjustment aims to increase resources for clinics based on the social risk of their patient population through a reliable, defensible, and transparent mechanism. This mechanism should then be aligned with processes to identify at-risk patients who can benefit from these resources.
In partnership with Agile Six and Social Innovation Ventures, Friends From The City designed and facilitated two policy design workshops to develop a future-state CMS payment system that incorporates social risk in a sustainable, equitable way.
CMS and industry experts gathered at the Cosmos Club in Washington, D.C. for a workshop focused on the future state of incorporating social risk factors into CMS payment adjustments. During these workshops, CMS, ASPE, safety net health plan providers, clinicians, and state representatives, collaborated to design new potential approaches to risk adjustment for Medicare and Medicaid programs.
The group discussed ways to ensure social risk-based payments actually address social needs rather than increasing profit margins for health systems and insurers.
