Medicaid Social Risk Adjustment in Oregon: Perspectives from Stakeholders.

Health care providers are often evaluated on patient health outcomes and quality of care measures. The social determinants of health play an outsized role in determining patient outcomes regardless of the quality of care delivered. As a result, providers caring for poor and underserved patients tend to receive lower value-adjusted payments, which exacerbates disparities in access to care. We conducted semi-structured interviews with 30 researchers, health policy constituents, and Medicaid payer and practice leaders in Oregon to better assess how to use social factors in risk adjustment modeling. While all 30 respondents agreed with the importance of social risk adjustment, we find that the experts have divergent perspectives on how to approach individual and community social risk. Moreover, many respondents felt dismayed because the data required are plagued by fragmentation and outdated privacy protection frameworks. Our findings suggest that alternative payment models must be better developed for low-income and underserved communities.

Collecting Social Determinants of Health Data in the Clinical Setting: Findings from National PRAPARE Implementation.

BACKGROUND: The Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (PRAPARE) is a nationally recognized standardized protocol that goes beyond medical acuity to account for patients' social determinants of health (SDH). AIMS: We described the magnitude of patient SDH barriers at health centers. METHODS: Health centers across three PRAPARE implementation cohorts collected and submitted PRAPARE data using a standardized data reporting template. We analyzed the scope and intensity of SDH barriers across the cohorts. RESULTS: Nationally, patients faced an average of 7.2 out of 22 social risks. The most common SDH risks among all three cohorts were limited English proficiency, less than high school education, lack of insurance, experiencing high to medium-high stress, and unemployment. CONCLUSIONS: Findings demonstrated a high prevalence of SDH risks among health center patients that can be critical for informing social interventions and upstream transformation to improve health equity for underserved populations.

Medicaid Investments To Address Social Needs In Oregon And California.

Health care organizations across the US are developing new approaches to addressing patients' social needs. Medicaid programs are uniquely placed to support these activities, given their central role in supporting low-income Americans. Yet little evidence is available to guide Medicaid initiatives in this area. We used qualitative methods to examine how Medicaid funding was used to support social interventions in sites involved in payment reforms in Oregon and California. Investments were made in direct services-including care coordination, housing services, food insecurity programs, and legal supports-as well as capacity-building programs for health care and community-based organizations. A mix of Medicaid funding sources was used to support these initiatives, including alternative models and savings. We identified several factors that influenced program implementation, including the local health system context and wider community factors. Our findings offer insights to health care leaders and policy makers as they develop new approaches to improving population health.