'A turning point': Inside the federal push to measure social determinants for the first time

CMS is in the process of creating a "universal foundation" of quality measures, setting the stage for the first time the federal government has tracked social determinants of health across all of its healthcare programs.

"This is a major shift and really a turning point in a number of ways for our federal approach to healthcare," Gary Price, MD, president of the nonprofit Physicians Foundation, told Becker's.

CMS shared in February that the universal foundation of 23 measures will function as a base for which programs can add additional aligned or program- and population-specific measures over time. The preliminary measurement categories for adults include wellness and prevention, chronic conditions, behavioral health, seamless care coordination, person-centered care and equity.

The measure set focused on SDOH was proposed by the Physicians Foundation and was first adopted by CMS last year for the Hospital Inpatient Prospective Payment System, starting voluntarily in 2023 and as a requirement in 2024.

"CMS also acknowledged the fact that current measures can lead to inefficiencies at the point of care for those of us delivering, and they gave a nod toward making sure that as they build this new system of measurements, there's concern for the efficiency of how that data is gathered," Dr. Price said. "That's very important."

The movement to standardize quality measures is 20 years in the making, according to Dr. Price. There's currently more than 20 federally-managed healthcare programs, along with different payment and care delivery systems, which makes quality measurements very inefficient and confusing. Though many health systems and physician groups already measure SDOH, universal federal acknowledgement and data collection around the issue has been a struggle.

"Although well-intentioned, I think a lot of current measures have shifted our focus away from things that truly matter," Dr. Price said.

Among the proposed measures, two would directly measure SDOH: the percentage of adult patients who screen positive for five drivers of health such as transportation and food security, and the percentage of adults that screen positive for one SDOH measure.

In February, CMS leaders wrote in The New England Journal of Medicine that many of the measures chosen represent diseases and conditions associated with the highest morbidity and mortality rates.

"Our intention is that the universal foundation will eventually include selected measures for assessing quality along a person's care journey — from infancy to adulthood — and for important care events, such as pregnancy and end-of-life care," they wrote.

The measurement shift is a welcome approach from the physician perspective according to Dr. Price, as past surveys from the Physicians Foundation have shown that 87 percent of providers wish they had more time to address their patients' SDOH. 

CMS has not provided a timeline for launching the new measures but said it will collect feedback on the proposal through various mediums, and work with states on any reforms to Medicaid/CHIP measures.

"I don't expect the entire system to be thrown out and then rebuilt from ground zero. I suspect it will be a gradual shift and improvement," Dr. Price said. "Proposing new measures and shepherding them through our system is a very complex process. It's not a quick fix, but it's an important one."

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