ISSUE: There are two key areas of debate about how social determinants of health (SDH) should be used to improve healthcare services and improve the accuracy of quality measurement. (1) Risk adjustment of quality measures. One side argues adjustment for SDH is critical to assure accurate comparisons of quality across plans. Systems that do not account for SDH may penalize providers and plans that disproportionately serve disadvantaged populations and adversely affect access to care. The other side argues adjustment for SDH will mask true disparities by adjusting away lower quality care and setting a lower standard. (2) The level of data and factors that should be evaluated to accurately capture the full impact of patients’ SDH. Published research has used readily available dual eligible and disability status as a proxy for SDH and/or Census data at the block group level which often does not find associations of SDH with outcomes. Emerging evidence shows that SDH beyond dual/disability status is important (e.g., education, income) and that using data at a more granular level is necessary to capture the impact of SDH on health outcomes.

OVERVIEW: This panel will discuss the issues around using SDH to improve healthcare outcomes. Christie Teigland will set the stage outlining the key issues of debate around use of SDH to improve quality, performance measurement, and payment structures. Karl Kilgore will review and critique existing literature on the relationships between SDH, outcomes, and costs, and present new evidence demonstrating that more precise SDH data is needed to accurately capture the association with outcomes. Matt Pickering will discuss how SDH affect medication access and quality using a conceptual framework. Angela Hagan will discuss the implications for population health management through the use of individual and community level SDH in predictive models and performance dashboards designed to provide key insights.