Study: More Collaboration Aids Health Care for At-Risk Populations

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By teaming with community organizations, doctors and hospitals can deliver high-quality care at good value to disadvantaged people at risk for poor health, according to a new report from a panel of experts.

The report released Thursday by the National Academies of Sciences, Engineering and Medicine was produced to aid Medicare officials studying how to fairly pay hospitals that disproportionately serve patients with social risk factors for health problems. Those factors include low income, social isolation, disadvantaged neighborhoods and limited health literacy. The report is the second of five commissioned for the Department of Health and Human Services.

Federal officials have announced the plan to move Medicare from a system in which doctors and hospitals are paid based on the volume of services they provide. The goal is a value-based payment system to encourage a better quality of care, better health outcomes and control costs.

Some research has found that hospitals serving disadvantaged patients may be more likely to receive poor quality ratings and receive financial penalties, the report said. Yet, an analysis of actual penalties under one of the new quality efforts to reduce the number of Medicare beneficiaries who are readmitted to a hospital within 30 days reported that so-called “safety-net” hospitals drew only slightly higher penalties than non-safety net hospitals, according to the National Academies panel.

“The drivers of these disparities in both health care quality and health outcomes are poorly understood and differences in interpretation have led to divergent concerns about the potential effect of (value-based payment) on health equity,” the report said.

The National Academies panel said some common themes emerged from its review of 60 case studies and peer-reviewed research. One was what can be accomplished when doctors and hospitals partner with social service agencies, public health agencies, community organizations and the community itself, the panel said.

A health system in that context may prepare a comprehensive needs assessment, according to the report, but its vision will be different if the assessment is grounded by a commitment to health equity and includes social needs as well as clinical needs.

“This report does show that socially at-risk populations do not need to experience low-quality care and bad health outcomes,” the report said.

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