Medicaid social risk adjustment in Oregon: A stakeholder analysis

With the increasing recognition of the important role a person's social and environmental context plays in the their health outcomes, health care and clinical systems across the United States have been focusing more on the social determinants of health. One mechanism to improve resource allocation and address health inequities is to account for a patient's risks through risk adjustment modeling. While risk adjustment has been occurring in some clinical settings, there is little agreement on how best to incorporate social information into such risk and payment models. Furthermore, there is an absence of published material examining the planning and implementation of these models, and even less incorporating the various health system perspectives. This issue brief highlights a set of key principles heard across partners in the Oregon Medicaid system to consider as the state defines and develops its risk adjustment methodology.