The Centers for Medicare and Medicaid Services has placed growing emphasis on social drivers of health, but little is known about how accountable care organizations (ACOs) aim to meet the needs of vulnerable patients.
A study by a team of researchers has found that ACOs participating in the Medicare Shared Savings Program (MSSP) has not advanced the development of work on social determinants of health (SDOH). This is the conclusion of the research published in the July issue of Health Affairs.
During September–December 2022, leaders of forty-nine Medicare Shared Savings Program (MSSP). were interviewed. Participants were asked about strategies to identify socially vulnerable patients, programs that addressed their needs, and Medicare reforms that could support their efforts.
7 ACO Themes Emerged
- ACOs were in the early stages of collecting social needs data.
- Leaders were frustrated by an incomplete ability to act on such data.
- ACOs tended to stratify patients by medical, rather than social, risk.
- Some ACOs have introduced pilot programs to address challenges, including social isolation and drug costs.
- Programs were often payer agnostic.
- Rural ACOs faced unique challenges.
- Medicare reforms related to reimbursement, logistical support, quality metrics, and patient benefits could support ACO efforts.
These findings suggest that the MSSP alone has not been sufficient to promote consistent investment in social needs provision at most ACOs. Policy makers may want to consider more direct support and incentives for health care organizations, or greater investment in non–health care sectors, to help socially vulnerable patients.
Why Coding Patients For Social Determinants Is Important To An ACO
Coding SDOH using standardized systems like ICD-10-CM (Z codes) and CPT enables the capture and analysis of critical social data affecting patient health. This practice offers several key advantages for Accountable Care Organizations (ACOs):
- Enhanced Risk Stratification and Care Coordination: By integrating SDOH data into patient profiles, ACOs can better identify high-risk individuals and tailor interventions to address their specific social needs. This proactive approach improves care coordination, reduces avoidable hospitalizations, and enhances overall population health management.
- Data-Driven Quality Improvement: SDOH coding enables ACOs to track and analyze social risk factors, facilitating the identification of care gaps and opportunities for improvement. This data-driven approach allows for targeted interventions and resource allocation, ultimately enhancing the quality of care and patient outcomes.
- Improved Value-Based Care Performance: Addressing SDOH can lead to better patient engagement, improved adherence to treatment plans, and reduced healthcare utilization. These positive outcomes directly contribute to ACO success in value-based care models by improving quality measures and lowering costs.
Lisa Remington
Lisa is a home care and health care growth and business development strategist. As president of the Home Care Leadership Think Tank and publisher of The Remington Report, she is well-known as a trusted industry advisor aligning strategic market intelligence into actionable strategies and business blueprints for decades. Lisa has led C-suite education to over 10,000 organizations through a variety of platforms, including think tanks, strategic improvement programs, board retreats, executive leadership programs, peer-to-peer networking groups, and advisory services.
