Measuring Health Care Quality: Opportunities and Challenges for Addressing Social Determinants of Health

• Activity Number: 131 - Translating Health Outcome Data into Real-World Understanding and Policies
• Type: Topic Contributed
• Date/Time: Monday, August 8, 2022 : 10:30 AM to 12:20 PM
• Sponsor: Health Policy Statistics Section
• Author(s): Sophia Chan*
• Companies: Centers for Medicare and Medicaid Services (CMS)
• Keywords: Medicare; quality measurement; rural health; social determinants of health; risk adjustment; value-based programs

Abstract

The Centers for Medicare and Medicaid Services (CMS) is the largest payer of health care in the nation. The agency serves Americans with a wide array of health care needs, many of which were partly the results of social determinants of health. The agency has implemented more than 20 quality reporting and value-based programs across care settings, using scientifically vigorous quality measures that could inform opportunities to close performance gap for medically underserved populations. In CMS' efforts to leverage quality measurement to improve health equity, the agency has confronted several methodological challenges. These include a lack of data that capture social determinants of health appropriately, a lack of consensus on how best to account of the impact of social determinants of health on health outcomes and resource use, and how to measure the quality of low-volume health care providers, especially those in rural areas. This presentation discusses the background of these challenges, how CMS has addressed them over the years, lessons learned, and the path forward for using quality measurement to drive health care transformation.