Social Determinants of Health in Managed Care Payment Formulas.

ABSTRACT:

Importance

Managed care payment formulas commonly allocate more money for medically complex populations, but ignore most social determinants of health (SDH).

Objective

To add SDH variables to a diagnosis-based payment formula that allocates funds to managed care plans and accountable care organizations.

Design, setting, and participants

Using data from MassHealth, the Massachusetts Medicaid and Children's Health Insurance Program, we estimated regression models predicting Medicaid spending using a diagnosis-based and SDH-expanded model, and compared the accuracy of their cost predictions overall and for vulnerable populations. MassHealth members enrolled for at least 6 months in 2013 in fee-for-service (FFS) programs (n = 357 660) or managed care organizations (MCOs)

SUBMITTER: Ash AS 

PROVIDER: S-EPMC5710209 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature