MassHealth Social Determinants of Health Risk Adjustment Model: Version 4.0
Alcusky, Matthew J Ash, Arlene S. Eanet, Frances E Fouayzi, Hassan Hager, Kurt Mick, Eric O. Min, Hye Sung Sabatino, Meagan J Williams, Jeffrey
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Health policy
Medicaid
Risk adjustment
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Abstract
The UMass Chan Medical School has worked with the Massachusetts Executive Office of Health and Human Services to develop risk adjustment tools for the Massachusetts Medicaid Program (MassHealth) since 2014. We have explored how social determinants of health (SDH) factors and medical complexity can be used jointly to predict healthcare cost. The first SDH model was implemented in 2016. It was replaced by SDH version 2.0 in 2018 and SDH versions 3.0 to 3.2 from 2020 through 2023. Here we describe the most recent work on SDH model 4.0, built using calendar year (CY) 2019 data for 1.03 million MassHealth members whose average total cost of care was $5,995. Model 4.0 includes some modifications based on MassHealth’s knowledge of policy and pricing changes that will be in effect in 2024 but had no influence on the 2019 data. Implementation of model 4.0 will start January 1, 2024.