Integra Insights


Big News at AHIP on Socioeconomic Status Impacting STARS and Risk Adjustment

On September 26, 2017 at AHIP in DC, Helen Burstin, MD, Chief Scientific Officer, from the National Quality Forum (NQF), John O’Brien, Deputy Assistant Secretary for Health Policy, and Young Joo, VP of Clinical Operations, Caremore gave us new homework and a new vision of importance regarding:

  • Social risk,
  • Medical risk, &
  • Community risk

and how it impacts payment models, risk adjustment and STARS.

In drips and drabs, we have seen CMS and HHS hint that social factors matter as they embed specific elements into STARS measurement, payment methodologies, and even risk adjustment.

What is our homework? We all need to read IMPACT Act, ASPE Report, the NQF studies and the about-to-be released NQF Equity Roadmap. They suggest that the healthcare community should routinely collect social risk, community risk, and medical factors to create a comprehensive member risk profile for integration into their care plan.