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How the CMS innovation center’s payment and delivery reform models seek to address the drivers of health

Horstman C, Bryan A, Lewis C
Commonwealth Fund

Issue: Social, economic, and location-based drivers of health (DOH) have an outsize impact on health — especially for Medicare and Medicaid beneficiaries, who are more likely to be elderly, have low income, or have complex medical needs. The Center for Medicare and Medicaid Innovation (CMMI) addresses DOH in many of their health care payment and care delivery models, but lessons from them have not been synthesized.

Goals: Describe how CMMI models have addressed DOH-related needs and identify factors facilitating or hindering participants from addressing these needs.

Methods: Review of evaluations, applications, and memos for 40 CMMI models.

Key Findings and Conclusions: In 23 of 40 models, participants addressed DOH-related needs to some degree. For some models, CMMI required these activities; in others, participants voluntarily pursued them. Common strategies included screening beneficiaries for nonmedical, social needs and/or referring beneficiaries to social services and community-based organizations. Participants were rarely required to assess or address DOH needs, however, and evaluations, when conducted, were not standardized. Participants noted that greater financial support, financial incentives, and technical assistance would enable them to better address patients’ DOH needs. CMMI might also consider requiring standardized DOH screening and incorporating performance measures in evaluations.

Horstman C, Bryan A, Lewis C. How the CMS innovation center’s payment and delivery reform models seek to address the drivers of health. August 8, 2022. The Commonwealth Fund. Available online.

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