New payment models must include social risks, Humana/National Quality Forum argue

Social, behavioral and environmental factors need to be incorporated into payment models that award providers for value over volume, according to a new paper published in the New England Journal of Medicine.

The paper, co-authored by William Shrank, MD, CMO of Humana, and Shantanu Agrawal, MD, president and CEO of National Quality Forum, argues that population-based payment models should evaluate both social risk and clinical risk. Incentives should be provided for addressing health-related social needs like food access, environmental safety and social support. 

"Growing evidence indicates that socially disadvantaged people have comparatively worse health outcomes suggesting that clinical and social risk are related," Dr. Agrawal said in an April 23 news release. "To improve the health outcomes of all people, including the disadvantaged, we must consider this growing body of evidence as part of a comprehensive, 21st century approach to risk adjustment."

Access the paper here.

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