The COVID-19 pandemic exposed long-standing racial and economic injustices embedded in our health care system. This has led to a renewed commitment to improve health equity and address the drivers of health (DoH) that account for 80 percent of health outcomes and have a disproportionate impact on communities of color. These include stable, affordable housing; healthy food; reliable income; and interpersonal safety, among others.
Advancing health equity and addressing DoH will require changing how and what we measure in health care. Measurement matters because it equips providers with data to identify and address unmet needs and allows policymakers and payers to account for DoH in payment models.
Despite the well-documented impact of DoH on health outcomes and costs and their impact on people of color, there are still no approved, standardized DoH measures in any Centers for Medicare and Medicaid Services’ (CMS) programs. Even without such measures, the impact of DoH interventions are much-referenced in the health care discourse and literature, but remain functionally invisible in federal health care policymaking. For example, while a growing number of CMS Innovation Center models are incorporating DoH screening and navigation on social needs, they use different tools and approaches. As a result, CMS cannot systematically compare or use the data. The same is true for race and ethnicity data, which are inconsistently measured or reported across CMS programs.
Recognizing the absence of DoH and race and ethnicity data as an issue, incoming CMS leadership in August 2021 cited the need for “patient-level demographic data and standardized social needs data” as a key element in its commitment to embedding equity in all models and demonstrations. The recently released CMS Innovation Center strategy report took this a step further by saying all new models will require participants to collect and report beneficiaries’ demographic data and social needs data, when appropriate. Providers have joined the call for standardized, patient-level data collection, citing their impact on patients, health care costs, and physician burnout.
In May 2021, in response to CMS’ annual invitation for new measures, the Physicians Foundation, which is directed by 21 state and county medical societies across the country, submitted the first-ever measures focused on screening patients for food insecurity, housing instability, transportation, utility needs, and interpersonal safety, including intimate partner violence. These measures have been used in more than 600 clinical practices via the Innovation Center’s Accountable Health Communities model and have been subject to rigorous and independent validation. CMS accepted them to its “measures under consideration” list, making them the first to address DoH out of nearly 3,000 total quality measures accepted for consideration in the past decade.
If approved, these measures would apply to two key Medicare programs — the merit-based Incentive Payment System and the Hospital Inpatient Quality Reporting Program — and provide a crucial foundation for comparable measures for the Medicaid Adult and Child Core Measure Set and guidance for states in their efforts to standardize DoH data.
While the proposed measures must still clear the review process, their adoption would represent a crucial milestone as the first standardized federal measures to assess social need in the history of the U.S. health care system.
Most important, when stratified by race and ethnicity and in combination with broader efforts to improve data collection, the DoH measures would make visible the social factors driving or inhibiting health, particularly for communities of color. Only when these factors are brought to light and measured in a standardized way will we be able to align our collective resources and take action to achieve equitable health outcomes for all.