1 / 16

Accounting for Social Risk in Payment and Delivery System Reforms in Massachusetts

Accounting for Social Risk in Payment and Delivery System Reforms in Massachusetts. Matthew Alcusky Assistant Professor Department of Population and Quantitative Health Sciences University of Massachusetts Medical School. Disclosures.

MikeCarlo
Download Presentation

Accounting for Social Risk in Payment and Delivery System Reforms in Massachusetts

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Accounting for Social Risk in Payment and Delivery System Reforms in Massachusetts Matthew Alcusky Assistant Professor Department of Population and Quantitative Health Sciences University of Massachusetts Medical School

  2. Disclosures The risk adjustment work discussed in this presentation was conducted using deidentified data as part of operations projects for MassHealth. Any results discussed in this presentation were from model development and do not represent model implementation by MassHealth. All statements and opinions are those of the speaker.

  3. The WHO SDH Framework1 1Solar O, Irwin A. A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion Paper 2 (Policy and Practice).

  4. The WHO Framework for Addressing SDH1 1Solar O, Irwin A. A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion Paper 2 (Policy and Practice).

  5. Ash AS, Mick EO, Ellis RP, Kiefe CI, Allison JJ, Clark MA. Social Determinants of Health in Managed Care Payment Formulas. JAMA Intern Med. 2017 Oct 1;177(10):1424-1430.

  6. Adjusting Payment, for whom? Massachusetts Residents, millions Subsidized Coverage 1.13 million managed care eligible MassHealth members as of 03/2019 http://www.chiamass.gov/enrollment-in-health-insurance/ https://www.mass.gov/files/documents/2019/05/02/masshealth-caseload-snapshot-and-enrollment-summary-march-2019.pdf

  7. SDH Variables derived from Administrative Data Individual Level Neighborhood Stress Score A measure of “economic stress” summarizing 7 census variables: - % of families with incomes < 100% of FPL - % < 200% of FPL - % of adults who are unemployed - % of households receiving public assistance - % of households with no car - % of single parent households - % of people >25 without a HS degree • Disability • Client of the Department of Mental Health • Client of the Department of Developmental Services • Medicaid due to disability • Serious mental illness • Substance use disorder • Housing Problems • Homelessness by ICD-10 code • Housing instability (>3 addresses)

  8. Observed/Expected Costs without Adjustment for SDH $4320 underpayment per person on a $6,000 budget $660 underpayment per person on a $6,000 budget $420 underpayment per person on a $6,000 budget Ash AS, Mick EO, Ellis RP, Kiefe CI, Allison JJ, Clark MA. Social Determinants of Health in Managed Care Payment Formulas. JAMA Intern Med. 2017 Oct 1;177(10):1424-1430.

  9. Incorporating SDH Variables into Payment Formulas *Diagnosis based risk adjustment underpredicted costs for those in the most stressed quintile of neighborhood stress by $130 per-member per-year

  10. Target Sites of Action: Incorporating SDH variables Incorporating SDH variables into payment formulas Strengthened safety net Improved healthcare access and outcomes for individuals

  11. Not Targeted: Incorporating SDH variables into payment formulas e.g., no increase in MassHealth or social services funding *Does not address causes of structural inequalities, reduce exposures to health-damaging factors, or reduce vulnerabilities e.g., no incentive for long-term investments in addressing intermediary SDH factors *The availability and quality of SDH data for risk adjustment remains limited

  12. The Massachusetts DSRIP Program1: 2017-2022 $1.8 billion DSRIP funds Startup/ongoing payments Flexible services payments 27 Community Partners (CPs) $547 million 17 Medicaid ACOs $1.1 billion Statewide Investments $115 million Flexible services payments 9 LTSS CPs Social Service Organizations 18 Behavioral Health CPs Care planning, care coordination for members with complex needs Nutritional, housing supports to address health related social needs 1Massachusetts DSRIP Protocol. Accessed 05/30/2019. https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ma/MassHealth/ma-masshealth-appvd-dsrip-prtcl-20190408.pdf

  13. Target Sites of Action: The Massachusetts DSRIP Program Reduced exposure to poor housing & nutrition Intersectoral integration, increased safety net workforce, population health management Improved identification and tracking of SDH needs, evidence generation

  14. A Few of the Remaining Questions: SDH and Massachusetts DSRIP • Will there be adequate buy-in, incentives, resources, and culture change for effective cross-sectoral action and health system transformation? • Is there an adequate supply of providers and resources to whom members can be referred once needs are identified? • What is the long-term effectiveness of time limited interventions to address intermediary SDH? • Will programs be sustainable after the DSRIP program ends?

  15. Closing: What are (aren’t) we targeting, how, and for whom? 1Solar O, Irwin A. A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion Paper 2 (Policy and Practice).

  16. Thank you Contact: Matthew.Alcusky@umassmed.edu

More Related