The Opportunity
Outcome measurement is an important tool in a value-oriented healthcare system. However, outcome measures must enable fair comparisons to support value-based purchasing and public reporting programs. Risk adjustment is a statistical technique used to identify and account for variation in patient outcomes that arise from differences in patient characteristics. These characteristics are also referred to as risk factors. The more frequent use of outcome measures in payment and public reporting programs has raised concerns regarding the adequacy of the risk adjustment methodologies used in these measures, especially as it relates to social risk factors like income, education, social support, neighborhood deprivation and rurality.
However, there are concerns that including social risk factors in the risk adjustment could mask healthcare disparities. Prior to 2015, NQF’s policy prohibited the inclusion of social risk factors in the risk adjustment models of measures submitted for NQF review and endorsement. After convening a panel of experts in healthcare disparities and measurement science to review the growing evidence of the impact of social risk factors on patient outcomes, the NQF Board of Directors implemented a two year trial period during which adjustment of measures for social risk factors were no longer prohibited. At the conclusion of the trial period in 2017, the NQF Board of Directors reviewed the results of the trial period and determined there was a need to launch a new social risk trial.
About the Project
Funded by the U.S. Department of Health and Human Services, NQF will implement the new Social Risk Trial as part of the Consensus Development Process (CDP). NQF will continue to allow measure developers to submit measures for endorsement with social risk factors included in their risk adjustment models. All measures submitted for NQF endorsement are considered to be part of the trial period. The CDP Standing Committees will be tasked with assessing the scientific acceptability of measures adjusted for social risk factors and submitted for initial endorsement or maintenance review. NQF will convene the Disparities Standing Committee and the Scientific Methods Panel to explore unresolved issues from the first trial period to advance the science of risk adjustment and provide guidance on the challenges and opportunities related to including social risk factors in risk adjustment models.
Related Work
Contact Information
For more information, please contact socialrisk@qualityforum.org.