All forward-thinking hospitals understand the role of social risk in providing effective, equitable and efficient care. In many ways, hospital objectives align with those of social risk assessment. Both help to distinguish acute from long-term needs, identify underlying contributors to poor outcomes, and, wherever possible, help minimize or completely prevent more serious interventions. Six social risk factors and their drivers Social risk is a measure of vulnerability as defined by specific social determinants of health. DataGen uses the following six SDOH categories. Social Determinants of Health Category Defined by Individual risk drivers Community risk influencers Digital Access, affordability and literacy Competency Resources Finance Strength, resources and resiliency Financial assets, liabilities and opportunities Income, cost of living and opportun...

CMS has introduced more than 50 innovative care delivery models designed to drive health system transformation over the last decade. Only six of those produced significant savings; of those, only four met the requirements to be expanded. As the second 10-year period of the program gets underway, which includes $10 billion in new funding, CMS’ Center for Medicare and Medicaid Innovation is considering numerous changes to improve the overall success of these programs and, in turn, drive overall gains in care outcomes and health equity. When evaluating what has worked in the past and what changes are needed moving forward, it is important to review what success looks like for Alternative Payment Model programs.  CMMI relies on three benchmarks to measure levels of success: The gold standard: improving quality of care while simultaneously reducing expenditures. Improving quality of care without impacting expenditures. Reducing expenditures without impacting qual...

In the first part of this blog, we discussed the “Discover” phase of working with community-based organizations to address social determinants of health. Next we’ll discuss the other steps in the Discover-Plan-Act cycle. In planning SDOH strategies, hospitals and health systems, guided by their Community Health Needs Assessments, are often best able to identify and convene key partners to address SDOH. The CHNA process brings neighboring healthcare providers and community-based organizations together to: learn from one another; gain commitment; share expertise; understand public policy efforts; and leverage technical and hands-on assistance. But, are these efforts sufficient? The recent HealthLeaders Social Determinants NOW Summit highlighted the conversations needed to identify, solve and scale collaborative SDOH programs with CBOs. The summit showed the importance of identifying, expanding and improving existing CBO wish list programs. In other words: leverage, scale, improve and ...

Partnership has always been essential to achieve healthcare's aims. And where there's a will — and a pandemic — there's a way. To find the way , hospitals and community-based organizations must partner in new ways to incorporate social determinants of health into patient care improvement efforts. Rich new SDOH data sets can supercharge the design, implementation and evaluation of SDOH initiatives as providers are expected to assume more responsibility for outcomes related to non-clinical factors.  The impact of social determinants of health  The pandemic resurrected a statistic that has been around for some time: 80% of health outcomes are based on social determinants, with only 20% dependent on clinical care.  People naturally understand it is harder for someone to manage their diabetes without access to affordable, healthy food. Through the federally-required Community Health Needs Assessment process, hospitals understand local need, but many do not yet know how to shif...

DataGen’s 2022 Enacted Medicare Cuts Analysis shows how hospitals have been impacted by existing Medicare fee-for-service provider payment cuts enacted by Congress to achieve Medicare payment policy and/or long-term deficit reduction goals. This analysis is provided to DataGen clients for advocacy purposes only . The impacts shown in this analysis include the major legislative, regulatory and quality cuts enacted since 2010 and are described below.  Enacted legislative cuts analyzed: Medicare marketbasket, Medicare Disproportionate Share Hospital and quality adjustments authorized by the Affordable Care Act of 2010; note that for this analysis, quality adjustments are broken out into their own category;  the effect of the 2.0% across-the-board sequestration reduction to payments authorized by the Budget Control Act of 2011, and the 4.0% sequestration reduction resulting from the calendar year 2021 triggering of the Statutory Pay-As-You-Go Act of 2010 (PAYGO);  inpatient c...