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Humana and the National Quality Forum Publish Population Health Paper in the New England Journal of Medicine

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Paper examines the importance of addressing social, behavioral and physical factors in ensuring better patient outcomes. Research underscores why the coronavirus is particularly challenging on historically disadvantaged populations and others facing health-related social needs.

Physician leaders from Humana Inc. and the National Quality Forum (NQF) explore the impact that social, behavioral and environmental factors – such as access to healthy foods, safe environments and social support – can have on physical and mental health and why these aspects need to be incorporated into payment models. The findings were published today in the New England Journal of Medicine (NEJM) in a paper titled “Clinical and Social Risk Adjustment – Reconsidering Distinctions.”

The paper, which is co-authored by William H. Shrank, M.D., M.S.H.S., Chief Medical Officer, Humana, and Shantanu K. Agrawal, M.D., Mphil, President and CEO, National Quality Forum, argues for evaluating social risk adjustment alongside clinical risk in population-based payment models, to provide incentives for addressing health-related social needs to improve health outcomes, rather than lowering the standards for their care.

“Growing evidence indicates that socially disadvantaged people have comparatively worse health outcomes suggesting that clinical and social risk are related,” said Dr. Agrawal, “To improve the health outcomes of all people, including the disadvantaged, we must consider this growing body of evidence as part of a comprehensive, 21st century approach to risk adjustment.”

A focus on upstream causes of poor health have been an emphasis of more recent value-based reimbursement models, with the goal of preventing disease and keeping patients healthy. The analysis and recommendations in the NEJM article build on a recent NQF and Humana collaboration, Food Insecurity and Health: Overcoming Food Insecurity Through Healthcare-Based Interventions. The guide highlights that social needs such as food insecurity and social isolation can lead to or worsen serious chronic conditions.

Crisis situations, such as COVID-19, can also create new social needs gaps and worsen those already present. Early research on the coronavirus pandemic indicates that the virus’s toll is particularly hard on historically disadvantaged populations and others facing challenges with social determinants of health.

Population health strategies must address these social needs, due to the downstream health impacts these cause and especially during a time of crisis, according to Dr. Shrank. “The COVID-19 crisis has underscored the inter-relatedness of social context and physical health,” said Dr. Shrank. “Our proactive outreach to our COVID-19-positive and highest risk members has uncovered high rates of social isolation and considerable barriers to accessing healthy food, which put them at higher risk for bad outcomes. Given the associations between social risk and clinical risk, it stands to reason that risk adjustment for payment models should incorporate the breadth of patient characteristics that predict the need for health care services.”

In addition to social needs, these individuals have also faced systemic barriers to accessing health care services and engaging in preventative health behaviors, leading to a higher prevalence of conditions such as diabetes and hypertension. The presence of these underlying chronic conditions has led to worse outcomes for COVID-19 patients.

For more information about Humana’s efforts to address the impact of social needs, especially among people living with multiple chronic conditions, please visit


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