There is clear evidence that links social determinants of health and health outcomes, however the link between these two things are not covered under current risk adjustment models. The National Quality Forum (NQF) and Humana recently came together to call for a new risk adjustment model that can account for clinical factors and social determinants of health. In a joint statement, NQF and Humana stated, ““We believe it is time for a meaningful reconsideration of the goal of, and approach to, risk adjustment writ large in quality measurement and payment systems,” and “the discussion should no longer be about the dichotomy of clinical risk versus social risk.”

Although NQF and Humana didn’t have any specific recommendations, they have outlined steps around creating such a model and they are pushing for providers to become engaged and play an active role in this call for change.

This is a topic that’s been discussed for years but has had little movement. Do you think it’s possible to create a risk adjustment model that includes social determinants of health? Some opponents believe that doing this would cause practical and ethical issues. Is that a legitimate argument?


You need to be a member of The NIC Collaboration Hub to add comments!

Join The NIC Collaboration Hub

Votes: 0
Email me when people reply –


  • Interesting Amanda.  I have been thinking about this for some time.  There are some differences between MAPD, ACA and Medicaid in how the models work which need to be thought through, and which data elements / how much to allocate are interesting questions.  Further, should this be integrated into risk adjustment or stars, or something else...?  Would like to explore with others who are you say, there are some practical and ethical issues to consider.  D

This reply was deleted.