2024 SOA ImpACT Conference Virtual - Session 3A: Social Determinants of Health, Health Outcomes, and Medicaid Risk Adjustment 11.13.24 Recording

Risk adjustment is widely used by public and private payers in value-based contracting and other risk-sharing arrangements aimed at addressing population health. Addressing social determinants of health (SDOH) and improving equitable outcomes is one of the aims of population health. Could SDOH be incorporated into risk adjustment? If so, how and how effectively? What implications might this have for market participants? In this session, Joan Barret, FSA, MAAA, from Axene Health Partners will begin by presenting background and findings from the 2022 SOA research report 'How Does Where you Live Impact Your Health?.' This is a question addressed through deep literature review and quantitative analysis, followed by an exploration of strategic approaches and barriers for payers and providers that wish to address SDOH inequities. Then, Rong Yi, FSA, MAAA, and Jeff Milton-Hall, FSA, MAAA, from Milliman will present their new SOA-sponsored analysis regarding integration of SDOH factors into Medicaid managed care risk adjustment. They will cover risk adjustment design considerations, policy and operational considerations for actuaries and states that wish to integrate SDOH into risk adjustment, simulated variation in financial outcomes for risk-bearing organizations when such integration occurs, and variation in the relationship of SDOH factors and morbidity to modeled risk across programs and populations. At the conclusion of the session, attendees will leave equipped to think critically and act effectively with respect to SDOH in their own work, from measurement and analysis design to actuarial interventions.