Should Medicare's Value-Based Pricing Be Adjusted for Social Risk Factors? The Role of Research Evidence in Policy Deliberations

Health services researchers now have enhanced opportunities for overcoming past obstacles to their work being relevant and useful for policy makers. Understanding the policy process itself is essential to taking advantage of these opportunities. Public policy making can be a complex process, and even the highest-quality evidence is only one of many factors considered and balanced during deliberations. We use a recent research report focused on social risk factors and provider performance as an example of the role evidence plays in policy deliberations. The report addressed the question of whether Medicare's value-based purchasing programs should be adjusted for patients' social risk factors. Despite high-quality and consistent results about the relationship between performance and social risk factors, policy deliberations did not result in a simple recommendation about making adjustments. Thus, the report offers a window into the role of research evidence in the development of policy.