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Designing the Future State to Account for Social Risks in CMS Payments

Policy design workshops reveal the impact of social risk factors in CMS payments.


American Board of Family Medicine


2021 - 2022

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Aligning healthcare resources with population needs based on social risk.

As a whole, social determinants exert a more significant influence on health than health care itself. However, Medicare and Medicaid, and most other payers, have not yet adjusted payments to better support healthcare providers.

Social-needs payment adjustment aims to increase resources for clinics according to the social risk of their patient population through a reliable, defensible, and transparent mechanism and align this mechanism with processes to identify at-risk patients who can benefit from these resources.

Designing the Future State to Account for CMS Payment Risks.

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.

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.