Highlights of the Symposium on Social Determinants of Health

In an effort to advance more preventive treatments, the Center for Medicare and Medicaid Innovation is testing 28 models that will base provider payment on quality and cost. The number is expected to grow in the coming years, said CMMI Chief Medical Officer Dr. Dora Hughes.

Alternative payment models, intended to ease the industry away from the typical pay-per-service model, vary by target health condition, practice location, and type of service provided. Perhaps the most famous is ACO REACH, or the Accountable Care Organization, which implements the equity, access and public health model. The values-based framework, which replaced the global and professional model of direct contracts earlier this year, requires participants to identify and describe plans to mitigate disparities among Medicare recipients.

In August, CMMI announced that 110 ACOs were provisionally accepted for the model starting January 1, 2023.

Another model presented at the symposium aims to address social issues along with six-state health care for children receiving health care or the Children’s Health Insurance Program. Its goals are to improve children’s health and reduce avoidable hospital stays and out-of-home placements, such as with foster families.

The third model, targeting maternal opioid abuse, targets postpartum mothers receiving Medicaid. Eight organizations are using enhanced care coordination and communication with social services to improve outcomes for mothers and their children.

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