NQF Initiative to Determine the Impact of Adjusting Healthcare Performance Measures for Social Risk Factors Highlights Successes, Opportunities 

JUL 19, 2017

CONTACT: Sofia Kosmetatos

NQF Initiative to Determine the Impact of Adjusting Healthcare Performance Measures for Social Risk Factors Highlights Successes, Opportunities

Washington, DC—The National Quality Forum’s (NQF) two-year trial to risk adjust certain healthcare performance measures for social risk factors found that this adjustment is feasible, with 17 measures endorsed by NQF adjusted for factors such as a person’s level of education. In a newly issued report, NQF reviews the findings of its initiative and highlights areas that need further exploration to provide a better understanding of how social risk factors can influence health and health outcomes.

“NQF conducted this trial because of our commitment to better understanding the impact of social risk factors on patients and providers,” said Shantanu Agrawal, MD, president and CEO of NQF. “Every stakeholder wants to see the quality of care for all Americans, especially the most vulnerable, improve while ensuring a level playing field for providers in value-based purchasing programs. The frequent use of NQF-endorsed measures for payment purposes underscores the importance of ensuring accurate comparisons of providers so that rewards or penalties are fairly assessed and based on true differences in performance.”

In the trial, NQF considered a total of 303 measures across 16 areas, including all measures submitted for review from April 2015 through April 2017, as well as 20 measures newly endorsed in 2014 with the condition of being considered for social risk adjustment. Of the total reviewed by NQF, 93 measures included clinical or some other form of risk adjustment. Of these, 65 measures had a conceptual basis for social risk adjustment, and 17 measures were endorsed with social risk adjustment.

Determining the impact of social factors on the quality of care patients receive and the outcomes of that care has been a focus of policymakers due to federal accountability programs that assess financial incentives and penalties on providers. NQF’s work, as well as recent reports from the National Academy of Medicine and the Office of the Assistant Secretary for Planning and Evaluation, add to growing evidence that individuals’ social risk factors impact their health and healthcare.

NQF began its self-funded trial in April 2015. A temporary change in NQF’s policy allowed measures to be adjusted for social risk factors, when warranted, as part of NQF measure endorsement review. Prior to the start of the trial period, NQF had only allowed measures to be adjusted for patients’ clinical factors present at the start of care. NQF’s Disparities Standing Committee (PDF) provided oversight and evaluation of the trial. This work has enhanced NQF’s focus on reducing and eventually eliminating disparities through quality measurement, and is developing a roadmap for how performance measurement and associated policy levers can reduce healthcare disparities.

The trial revealed challenges in obtaining data on social risk factors, including data granular enough to accurately reflect individuals’ social risk. NQF also noted the varied methods that measure developers used to test the effect of risk adjusting measures for social factors, which could have limited the effects of risk adjustment. For example, some developers added social factors into the risk model after clinical factors, limiting the amount of variation seen related specifically to social factors.

NQF’s report suggests that important issues highlighted in the trial, such as the availability of data, should be pursued in the collective drive toward eliminating healthcare disparities.


The National Quality Forum leads national collaboration to improve health and healthcare quality through measurement. Learn more at www.qualityforum.org.