Accounting for Social Risk in Medical and Social Service Payments in an Age of Value-based Purchasing

Topic Overview

A mix of social, environmental occupational, and economic factors collectively labelled the social determinants of health (SDH) have a greater combined influence on the morbidity and mortality of our patients than the services we deliver in traditional medical care.

Addressing SDH can prevent illness and unnecessary services and produce better health. And yet, U.S. health care payments do not typically adjust for these factors to support related needs and services and do not support tools, teams, or delivery redesign needed to adequately address SDH. 

The 2014 IMPACT Act directed the United States Secretary of Health & Human Services to review the evidence linking social risk factors with performance under existing federal payment systems and to suggest policy options. Most U.S. states now require assessing and addressing social determinants in Medicaid contracts, but most of these offer insufficient specificity or adjustment tied to accountability. And while there are several research studies and philanthropic demonstrations focused on addressing social determinants, there is little U.S. evidence available on which to build.

Other countries, including England, have for decades routinely adjusted payments for health care and social services to account for neighborhood deprivation. These international examples, and related models in the U.S., have the potential to improve the effectiveness of value-based purchasing and health for the nation.

There are several, related small-area SDH indices in the U.S. with a growing amount of evidence of their relationships to important health outcomes, avoidable hospitalizations, and disease prevalence. These indices are potential candidates for meaningful and reliable health services payment adjustment.


Peter C. Smith, MSc – Emeritus Professor of Health Policy at Imperial College and Professor of Global Health Economics at the University of York

Amy Kind, MD, PhD  Director of the Health Services and Care Research Program and Associate Professor of Medicine (Geriatrics) at the University of Wisconsin School of Medicine and Public Health

Matthew Alcusky, PharmD, MS, PhD Candidate  Assistant Professor in the Division of Epidemiology, Department of Population and Quantitative Health Sciences at the University of Massachusetts Medical School


Wayne Jonas, MD  Executive Director of Samueli Integrative Health Programs at Samueli Institute


Accounting for Social Risk in Medical and Social Service Payments: The English Experience(1 MB PPT)
Peter C. Smith, MSc

Leveraging Research to Address Social Determinants of Health(12 MB PPTX)
Amy Kind, MD, PhD

Accounting for Social Risk in Payment and Delivery System Reforms in Massachusetts(1 MB PPTX)
Matthew Alcusky, PharmD, MS, PhD Candidate