Medicaid Social Risk Adjustment in Oregon: Perspectives from Stakeholders

Health care providers are often evaluated on patient health outcomes and quality of care measures. The social determinants of health play an outsized role in determining patient outcomes regardless of the quality of care delivered. As a result, providers caring for poor and underserved patients tend to receive lower value-adjusted payments, which exacerbates disparities in access to care. We conducted semi-structured interviews with 30 researchers, health policy constituents, and Medicaid payer and practice leaders in Oregon to better assess how to use social factors in risk adjustment modeling. While all 30 respondents agreed with the importance of social risk adjustment, we find that the experts have divergent perspectives on how to approach individual and community social risk. Moreover, many respondents felt dismayed because the data required are plagued by fragmentation and outdated privacy protection frameworks. Our findings suggest that alternative payment models must be better developed for low-income and underserved communities.