Healthcare Economist April 12, 2021
Jason Shafrin

If you want to implement value-based care, you need to define what a ‘good’ outcome is. A good outcome may be different for different individuals. For instance, if you look at mortality rates for a given disease, it makes sense that individuals age 80 and above will have higher mortality rates than those 20-29 year old with the identical condition. If you are measuring physician or hospital quality, you will want to control–or “risk-adjust”–for these differences in patient characteristics. Traditionally, risk adjustment controls for patient demographics and medical conditions. However, should you control for social factors such as poverty or education? There is a lot of debate:

The current policy of the National Quality Forum (NQF) allows adjustment for...

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Topics: CMS, Govt Agencies, Healthcare System, Insurance, Patient / Consumer, Payment Models, Provider, SDOH, Value Based
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