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Social Determinants of Health and Massachusetts Payment Reform

August 9, 2017

In January 2018, MassHealth -- Massachusetts’ Medicaid program -- will be implementing a full rollout of a Medicaid Accountable Care Organization (ACO) program as part of the State’s 1115 Medicaid waiver (also known as DSRIP). This program has been lauded for the emphasis on establishing community partnerships and on social determinants of health (SDOH). One of the innovative ways that Massachusetts is incorporating SDOH is through the risk adjustment methodology used to determine payment to participating ACOs.

The objective is to allow adequate payments for providers to make the necessary adjustments to care delivery models, making resources available where they are most needed and can be most effective. While adjusting payments for SDOH is not the same as requiring providers to change care delivery models, it may be an important step in making resources available where they are most needed.

JSI and MLPB co-authored the Risk Adjustment’s New Frontier: Social Determinants of Health brief. This brief articulates why this development, albeit nuanced and complex, offers substantial promise. The brief attempts to demystify risk adjustment for non-experts, and lay a foundation on which the following questions later can be explored:

  • Can risk adjustment methods geared to support the sustainability of healthcare delivery systems evolve to incorporate a health equity lens?
  • Can payment methods that account for SDOH risk factors play a role in reducing health disparities, thereby better meeting both sustainability (cost) and equity (outcome) goals?


Interested in learning more about this publication? Email Melinda Stylos-Allan at Melinda_Stylos-Allan@jsi.com