Dr Shantanu Agrawal on the Challenge of Adjusting Measures for Social Risk Factors

There is some controversy in healthcare about whether or not healthcare performance measures should be adjusted for social risk factors, and Shantanu Agrawal, MD, MPhil, CEO and president of (NQF), outlined both sides of the debate.

What is the debate regarding adjusting healthcare performance measures for socioeconomic status?
I think there has been some concern. First, from the provider community, there has really been this question of: If these social risk factors are impacting the kind of care that either patients are available to get access to, for example, things like transportation and security, or the outcomes of the care that I’m delivering, then how do we take that into account for quality measurement? And I think their big, sort of main, goal is to make sure as we are comparing providers through quality measurement, that that comparison is fair and really takes into account their patient population.

At the same time, I think there are folks who want to make sure that by risk adjusting for quality measures, we’re not, somehow, holding providers to a different standard or allowing these population to not get the care and services that they need.

Our position has certainly been, we are very understanding of these positions, which is why we do this work within the broader health equity program that NQF has launched. So that we make sure we are implementing measurement approaches that are good from a health systems standpoint that make sense for patients and providers, but at the same time really thinking about the interventions and surfacing the interventions that work to reduce disparities.

These things really must, I think, hang in concert with each other. Both are necessary so that our approach to measurement is acceptable, but also that we are really driving the changes that we all need to see happen.
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