Landscape of area-level deprivation measures and other approaches to account for social risk and social determinants of health in health care payments
- Collection:
- Health Policy and Services Research
- Author(s):
- Breslau, Joshua, author Martin, Laurie T. (Laurie Thayer), 1974- author Timbie, Justin William, author Qureshi, Nabeel Shariq, author Zajdman, Deborah, author
- Contributor(s):
- United States. Department of Health and Human Services. Office of the Assistant Secretary for Planning and Evaluation. Office of Health Policy, issuing body. RAND Health Care, issuing body.
- Publication:
- Washington, D.C. : Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Office of Health Policy, September 2022
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Reimbursement Mechanisms Medicaid Risk Factors Social Determinants of Health -- economics United States
- Genre(s):
- Technical Report
- Abstract:
- This report is intended to provide an informational resource that will support emerging policy strategies. Specifically, we examine existing methods for measuring social risk within geographic areas using area-level social deprivation measures and for incorporating these and other measures into payment models. For the purposes of this report, social risk factors include measures of both (1) social determinants of health (SDOH), or structural inequalities that are associated with poor health, such as income or education, and (2) health-related social needs (HRSN), or individual-level consequences of SDOH, such as homelessness or food insecurity. The broad focus on social risk factors is important because of the wide variety of policy strategies in which area-level measures of social deprivation may be used to allocate resources, some of which may focus more on SDOH and others on HRSN. To capture a variety of social risk factors, we expanded a classification of social risk factors that was developed by the National Academies of Sciences, Engineering, and Medicine (NASEM) in a report titled Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors (NASEM, 2016). In the NASEM framework, race is used as a proxy for the social risk factors of racism and discrimination because persistent systemic and institutionalized racism has denied members of certain racial groups equitable access to social, economic, and educational resources--such as stable housing, access to food, and safe neighborhoods--that affect health-related outcomes. Because the NASEM classification focuses primarily on SDOH, we expanded the classification by adding HRSN, drawing on a screening tool developed for the Accountable Health Communities program (Billioux et al., 2017). Combining these two sources, our classification includes the following six domains (with examples of related indicators) (1)socioeconomic position: income or wealth, education, occupation; (2) race, ethnicity, and cultural context: race/ethnicity, language, nativity, acculturation; (3) gender: gender, gender identity, sexual orientation; (4) social relationships: marital status, social support; (5) residential and community context: community socioeconomic composition, built environment; (6) social needs: housing instability, food insecurity, interpersonal safety.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (viii, 93 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918574082106676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918574082106676