American Board of Family Medicine
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.
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.
