It’s time to measure what is really important-the social drivers of health


Every day, our healthcare system spends US$11 billionAs a practicing physician, it is clear that the fees our system measures and pays—through diagnostic and billing codes, “allowed services”, and countless quality metrics—reflect what and who it values.

We at the frontline of healthcare know that only by solving the following problems can we reduce the total cost of care and achieve health equity Healthy social drive— Severe comorbidities, such as food insecurity and housing instability.

However, this is not how our system works. Under the federal payment and quality framework, the healthcare system encodes, screens, measures, and adjusts risks for diabetes, not food insecurity—even food-insecure diabetic patients have worse health outcomes than people with food insecurity, on average every year Of diabetics spend an extra $4,500. Get healthy food.Systems that do not collect food insecurity data and take action cannot address rising health care costs or reduce racial disparities, especially considering that black Americans face the highest rates in both cases Food insecurity with diabetes.

Similarly, social drivers lead to Doctor burnout And effectively punish doctors who take care of affected patients by the following methods Lower MIPS score. A sort of Recent studies It was found that SDOH was associated with 37.7% of the price-adjusted medical insurance expenditure difference between the counties with the highest and lowest quintile of expenditures in 2017. However, even if the ongoing pandemic makes these problems painfully highlighted, SDOH is still not included in any geographic adjustments or cost benchmarks.

For more than a decade, the Physician Foundation, led by doctors from 21 state and county medical associations, has been at the forefront of identifying these challenges and taking action.Recently, we found Four key principles And the relevant actionable policy recommendations on how to solve SDOH, that is, how we can pay and provide medical services to improve health, while reducing costs and reducing the administrative burden on doctors.

A key principle is that new standards must be established for SDOH quality, utilization, and outcome measurement.Every year, the Medicare and Medicaid Service Center invites Proposals for new measures Align with the organization’s priorities. CMS is committed to identifying new measures that are meaningful to patients and providers, reducing the number of health insurance quality measures and reducing the burden on users. Therefore, it has recently announced that it will prioritize the development and implementation of Social and economic drivers.”

In response, the Physician Foundation submitted its first SDOH measure for consideration by CMS, focusing on screening patients for food insecurity, housing instability, transportation, utility needs, and interpersonal safety.These measures are Well tested, Including through Responsible healthy community model, It has screened nearly one million beneficiaries for SDOH in more than 600 clinical practices. Recognizing the need to rebalance quality measures to focus on SDOH-it drives 70% of health outcomes and related costs-we further recommend that for every such measure adopted, CMS should deactivate at least three other processes And/or efficiency measures.

In July, CMS formally incorporated these proposed SDOH measures into consideration of two key federal payment plans for clinicians. As a background, between 2013 and 2020, 2,864 measures were submitted for consideration through this process—but none of them involved food, transportation, and other social drivers of health.

These proposed SDOH measures still have important milestones that need to be clarified through the National Quality Forum Measures Application Partnership, but if they come into force, they will become the first federal SDOH measures in the history of the US healthcare system. If they fail in the last mile, the CMS measurement gap will persist—and, more importantly, we will lose the long-overdue bridge between the realities of patients’ lives and doctors’ practices and the regulatory mechanisms of our healthcare system chance.

The government is committed to implementing equity; a pandemic has exacerbated food insecurity, housing instability, and other social drivers of health and the clinical disease burden associated with these factors; and the Medicare Trust Fund is expected to Insolvency Five years later, it is time to insist on acknowledging these SDOH comorbidities and take action.



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